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What is a Hepatic Coma?

By Amanda Barnhart
Updated Mar 03, 2024
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A hepatic coma is a loss of consciousness due to a liver problem or liver failure. When liver tissue is destroyed or diseased, it cannot properly process toxins in the blood. These toxins can poison the brain, causing the patient to slip into a coma. Hepatic encephalopathy occurs when the brain is damaged from toxins normally processed by the liver, and a hepatic coma is the last stage of the condition. In some cases, doctors can treat the underlying condition affecting the liver, but in severe cases with irreversible liver damage, the comatose patient will eventually die.

Hepatic encephalopathy typically occurs in patients who have a chronic liver disease, such as cirrhosis or hepatitis, though it can occur suddenly in people who had no previously diagnosed liver problems. Gastrointestinal bleeding leads to excess ammonia and other toxins in the body, which cannot be properly filtered if the liver does not function well. Eating excessive amounts of protein, dehydration, kidney problems, infections, and electrolyte imbalances can also lead to hepatic encephalopathy.

Patients who eventually slip into a hepatic coma usually exhibit mild symptoms before they become comatose. The most common symptoms of hepatic encephalopathy are confusion, mood changes, memory problems, inability to concentrate, changes in sleeping habits, and a sweet or musty breath odor. Since these symptoms can be indicative of many other diseases as well, it is important to seek medical treatment if a patient exhibits sudden changes in breath odor or mental function. As the condition progresses, patients with hepatic encephalopathy may develop speech problems, drastic behavioral changes, or abnormal hand or arm movements.

Doctors use several different tests to diagnose hepatic encephalopathy in patients who are in a hepatic coma or who are progressing to that stage. Blood tests can measure ammonia levels and levels of other toxins in the blood. Electroencephalography (EEG) tests help doctors measure brain activity to show abnormalities that could be caused by poisoning of the brain tissue.

Patients in a hepatic coma are treated for the underlying problems that prevent their livers from functioning normally. Doctors treat gastrointestinal bleeding and treat infections, kidney problems, and electrolyte imbalances with intravenous medications. Comatose patients may need life support machines to help them breathe and keep blood circulating through their bodies. Protein must be restricted as well. In severe cases, a liver transplant may be necessary to save the life of a patient in a hepatic coma.

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