What Causes Hepatic Encephalopathy ?

What on earth causes hepatic encephalopathy and more to the point what is it?

Well it certainly is one of the reasons that I am alcohol free and now enjoy a range of alcohol free beers, wine, gin and fizz.

Alcohol did not go well with my liver even as a social drinker. Now with your liver and alcohol if you are not careful your disease can get very badly harmed and worst in the worst case scenario you will get liver disease.

Through a mixture of genetic, relatively normal drinking and stress my liver packed up. Welcome to my world but the good news is I am learning a lot about alcohol free drink options and my own liver!

Alcohol and Liver Disease

I with liver disease I have to be aware of hepatic encephalopathy. What the hell is it and why the complicated name?

Well that medics for you as brilliant as they are!

So before I get going, I am not a doctor or medical expert but I do have liver disease so that puts me up there with having some knowledge.

However, as disclaimer always get medical advice or you can read more at the British Liver Trust who were very helpful for me.

And even with all the info out there I have learned that eventually you have to do some digging yourself when it comes to liver disease, alcohol and hepatic encephalopathy.

Self-education is often part of the process.

The same is true for jaundice, cirrhosis, fatty liver, alcohol free options, alcohol advice and the rest of it. Society and its judgment of the liver and alcohol are not really geared up to be the most helpful or friendliest.

You either an alcoholic or not, and poor liver patients get alcohol shamed even when they have never had a drop in their lives!

I had a really bad episode this weekend in terms of Hepatic Encephalopathy so I thought I know I will blog about it, after all that’s why we are here.

Bear in mind this is a personal account so please get more advice from your GP, or the UK Liver trust who I have to say are brilliant!

What is hepatic encephalopathy?

To be honest I don’t think I was ever told what it really was. I was just given some white liquid told not to squish it around my mouth as it contained lots of sugar and it would keep me regular.

Given I was told my liver might fail and I might die, I took anything I was given without question.

To be fair my medical care was first class even if at times I had no idea what was going on!

Hepatic encephalopathy means for me personally that it can lead to total confusion and even my personality can change a bit.

No that’s not good on any level.

What Causes Hepatic Encephalopathy

In fact for a few days I had not taken one of the few medicines on my list as I felt totally fine. Then I became more anxious and confused and my partner of course thought it was about us.

It was actually a decline in my brain function which to be fair is normally first class.

It happens as a result of having very severe liver disease.

The good news is I am living with it and I am probably fitter than many.

Read Living with Liver Disease the Awful Truth

Being blunt about it, my liver is not working at full capacity, its damaged and in my case very badly.

And you wonder why I am an advocate of alcohol free drink here at 00abv.com.

This is one of the reasons, even as a social drinker you don’t need to be over the recommended amount of alcohol to start doing damage.

Most people think ( and others have told me this of themselves too ) that people think of us as having a life on a park bench with a bottle of vodka in our hands.

Even some alcohol therapists think this!

The reality is we were probably having a few large glasses of wine down the pub after work surrounded by people drinking far more than us!

True! I have had so many stories from people just like be I was actually amazed how similar out stories were.

So what is this so called hepatic encephalopathy?

When alcohol combined with factors like stress or genetics damages our liver we are left with more toxins in our blood that we should have.

The best way I can sometimes describe it is like a sugar crash as a diabetic could have. The liver just ain’t working well!

Sugar Crash

The body gets confused and that is not good news and can get very serious even putting any mood swings aside for a moment.

So my headline is to think of toxins in your blood that the liver cannot fully remove or at least as a problem doing so .

I know from talking to medical professionals that they see all types of Hepatic Encephalopathy which can happen over a short period or become very serious and long term resulting in a coma in some extreme cases.

Luckily mine is scary, unpleasant but mild generally and I can go weeks without it happening at all!

Kind of confusing for those around you who don’t understand and know your normal behaviour pattern well.

As we know personality change can be unsettling for everyone but as I say as a coach awareness is key.

Once you know about something you can begin to get some steps to understand it more and take action in conjunction with a medical professional who ideally has a knowledge of liver disease.

Luckily my local doctor is very understanding and probably saved my life.

Are there different types of hepatic encephalopathy?

Well the causes of liver disease certainly varies.

I actually feel upset for liver patients who don’t drink and never have and yet when they say they have liver disease they are presumed to be an alcoholic.

People often tell me “but you were never drunk so I don’t get it”.

While not being totally true I was probably at work parties even dealing and helping people who had a few too many and I was the sober one in comparison.

Just shows you!

And to my point people really judge others badly not just about alcohol but also about liver disease. And yet it is so much more complicated.

Living with Liver Disease


Acute hepatic encephalopathy develops because of severe liver disease and there is no doubt about that I can not even begin to be an expert of the various reasons for it.

The British Liver Trust is a great starting point.

The issue mainly occurs in people when this stuff happens.

  • Damage to our liver can occur through viral hepatitis, or toxins like alcohol, chemicals, drugs,
  • There are other medical conditions that can causes this and can lead to total liver failure.
  • Hepatic encephalopathy and its symptoms can be permanent or ad hoc as in my case. But their effects can be very scary.
  • I personally have to accept that if you have severe cirrhosis, or really bad scarring of the liver you will need to keep a close eye on it big time and luckily the consultant at my hospital was all over it.

However, people can have liver issues where the causes are never found and I know people who have been personally affected by this and in one case had to have an emergency liver transplant. These are never an easy options.

Here is the thing though, they had never drunk alcohol in their life and yet there are people who are big social drinkers who end up being fine!

What are my symptoms of what many would call moderate hepatic encephalopathy?

These can vary person to person which is why getting expert medical advice is key. This is a personal blog after all.

However, during an episode and afterwards I can be aware the following scary symptoms

  • Difficulty thinking on what should seem a simple thought process becoming complicated and to use a well-thought-out metaphor I simply “can’t see the wood for the trees!”
  • My personality changes from its usual clam centered self. I am kidding here as I am eccentric as they come but I can become very erratic and certainly very moody. More than normal !
  • I find it hard to concentrate on simple tasks even though in my mind I know what should be done!
  • My brain gets confused and interprets other people’s behaviour in the wrong way. So I can be even more irrational than usual!
  • I might become more forgetful and actually it’s certainly not the time to be making judgments on business day to day life decisions.
  • I might become very tired and just put myself to bed for example.
  • Anxiety increases

Anxiety and the Liver

Now the reason you need to get medical help for this is that it can turn very serious indeed with cirrhosis of the liver crisis or where your liver is badly damaged.

I can only go over my causes as I would see them and in reality I just know.

I am just going by my own experience of having liver disease and of course my expert medical care.

But on a serious level you could go from being confused to being in a coma so please don’t dismiss these symptoms as just a bad mood and get them checked asap.

You can learn more about liver disease from the NHS here. ( Based in the UK but relevant world over)

What treatment do you get for hepatic encephalopathy?

This is probably the simple bit. I am back to that sweet medicine that keeps me regular if you know what I mean!

It’s called Lactulose and clearly treatment will vary depending on the seriousness of your condition.

But let’s go back to patient basics as I understand it.

What treatment do you get for hepatic encephalopathy

The problem is simple, my liver is a key organ and I would say as there is less written about it when compared to your brain or heart.

Now once the liver is past a certain point in damage terms it is likely to not heal but regardless of this how serious your liver disease is will determine the treatment as well as the symptoms.

The severity of the condition and potential triggers will determine the treatment given. I have to say my liver medic team was more keen on my treatment than the pharmacist but I have no idea why.

I guess the liver is a specialist area and judgment was withheld totally. That really helped.

I went with my liver excerpt consultant’s view!

The good news is as long as I take my treatment regularly and keep an eye on my symptoms I am normally fine.

It’s also worth remembering that liver issues come with their own diet which I write about and getting a dietitian on board was key for me.

Best Diet for Liver Disease

Read my best diet for liver disease and how important my dietitian was

As well as switching to an alcohol free lifestyle and you can check out my alcohol free fizz here which I now can enjoy and be totally alcohol free.

Now the only experience I have of treatment of Hepatic Encephalopathy is my being given something called Lactulose.

When I first got given this and told not to swig it around my mouth like mouthwash it was simple to understand. It’s actually about tooth decay. It’s full of sugar.

I know how bizarre.



Its man made type of sugar that reduces the acidity of your digestive system and in practice your stools. Imagine having this conversation with your doctor.

Of course, they don’t blink their eyes and why would they!

Remember the toxins and ammonia can get into your blood system and then into your brain which is where the confusion and change of character can come from.

So lactulose is probably the easiest part of me living with liver disease to understand. It’s simple, it just reduces or stops excessive bacteria growing in my bowel.

And that is because my liver can’t work at full capacity.

Kind of makes sense right?

So now you know what causes hepatic encephalopathy

And of course it will vary from patient to patient which is why I am not here to be your doctor but someone to say “hey I’m here, I have the t-shirt and I am living with it” does really help.

As long as you are aware of it certainly as far as I am covered it is treatable but don’t get cocky about it. Keep checking for symptoms and get help.

Alcohol Free Lifestyle

Do adopt a reduced alcohol lifestyle and know your limits through drink aware. I no you don’t need to be downing a bottle of vodka on park bench unless of course you are for this to become an issue with liver disease!

But knowing where you are on any scale is key to any change!

You could just be a social drinker and like me with stress the liver decides it has had enough even when all around you seem to be drinking away with no consequences at all.

All our thresholds are different.

It’s why I am passionate about alcohol free gin, beer and wine. We need good alcohol alternatives. Good Choice is key to this.

I would love to know your view on what causes hepatic encephalopathy? Have you ever heard of it before? Are you aware of the impact it could have and do you think ?

Leave your message below on what causes hepatic encephalopathy and I will always get back to you. I really value your comments.



8 thoughts on “What Causes Hepatic Encephalopathy ?”

  1. Hello

    Hepatic encephalopathy is not a good disease to have at all. The worst part is that medical professionals often throw the diagnosis at a patient and forget to explain what really that means. I can see that it did happen to you as well. So sorry to hear that. ! am however glad that even though you are living with a liver disease, you are still quiet fit. It is commendable what you are doing to raise awareness about this not so good disease.

    Even though I do not have any alcohol related problems, I am also an advocate of Zero Alcohol lifestyle. Alcohol is not good in all aspects for the body. In my years as a clinician, I have seen so many people with hepatic encephalopathy and how it has affected their quality of live. That is why I advocate for no alcohol because many people are not capable of drinking responsibly. 

    Alcohol does not affect the body only but does affect the socio economic aspect of an individual. We all need our livers to be functioning well and hence we need to make the right choices with our lives.

    Thank you for writing this very informative post. i believe it will surely save many people’s lives

    • Hey Boi, thanks so much for this really fantastic comment, and its great to have someone who really understands this issue inside and out. I can’t tell you how much I value this and your kind thoughts. I know it will add support to many. I really appreciate it, all the very best, Phil

  2. This information has really opened up my eyes to understand a lot more about liver disease and how severe it can become.  The main thing to remember is that it would probably behove all not to drink alcohol which will bring about much better health.  Thank you for taking the time to share how we can be more aware of the symptoms of this disease and howvto overcome it.

    • That is my pleasure, the liver is a complicated organ but yes too much alcohol can lead to liver damage so you make a great observation. I was shocked just as a social drinker how it affected me. Its also a very misunderstood area which is why the UK Liver Trust can really help people understand. Thanks so much for taking time out and making a valuable comment, it is very appreciated, all the best, Phil

  3. Well, this article is eye-opening. Thankfully I have always been very good at managing my stress and I guess I might have a bit of luck with genetics but I definitely am worried about drinking now compared with how much I used to drink. My liver seems to be ok thankfully. 

    For me, the problem is that I don’t want to be around drunk people if I am completely sober. I gave up drinking when I was training for boxing but I still attended 2 social occasions. I certainly see value in a 0 alcohol lifestyle but if I am not drinking I am probably not going. If I do go I may have 2 or 3 or sometimes I will have a few more… maybe now I will reconsider and get another health check

    Thanks for the info 

    • Hey Alex, you have some great thoughts there and yes its always good to keep an eye on your alcohol intake. I think a social circle is key to getting the right balance as you say. Its one of the reasons I find alcohol free drink options so helpful. 

      I really appreciate you stopping by and adding some excellent insight. It is much appreciated, Phil

  4. Hi Phil,

    This is a good article.  I kind of heard of this before but really only the term and I work in the medical field but not a nurse or anytime of clinician.  I was wondering, is this a hereditary disease?  I am also not a drinker but not for liver reasons.  I  like that you are showing non-alcohol related beverages.  I just don’t like how alcohol makes me feel, so having non-alcohol choices helps me too!

    • Hi Chris, thanks so much for your comment, its really appreciated. I know  What Causes Hepatic Encephalopathy is mixed but its generally concerned with liver function. 

      However there are many factors that can influence liver disease incuding various diseases but I have not heard of it being a hereditary disease of and of itself as its more a symptom of the liver not working rather than a disease in itself. 

      Having said that genetics, stress and various condtions can affect the liver. The British Liver Trust is a great reference point for this. Your comment and questions are brilliant so thanks for stopping by. All the very best, Phil


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