Hepatic encephalopathy: Thinking Beyond ammonia
Hanna Blaney, M.D., M.P.H.,* and Sharon DeMorrow, Ph.D
Hepatic encephalopathy (HE) is a syndrome of impaired brain function due to acute and chronic liver disease and/ or portosystemic shunting. Manifestations range from subclinical psychiatric and neurological disturbances to coma. It is associated with high morbidity and mortality and contributes to high health care utilization. Although the pathophysiology of HE is not fully understood, it has been linked to the presence of inflammatory mediators and circulatory neurotoxins, such as ammonia (Fig. 1).