What Is the First-Line Treatment of Overt Hepatic Encephalopathy?

Overt hepatic encephalopathy (OHE) is a neuropsychiatric complication of liver disease that requires prompt, structured intervention. First-line management follows a defined sequence: rapid identification of the episode trigger, a targeted pharmacological intervention, and immediate nutritional support — all initiated together.

The cornerstone of initial management is identifying and correcting the precipitating factor — which may include infection, gastrointestinal bleeding, electrolyte disturbance, or constipation. Correction of the precipitating cause alone resolves the majority of episodes. Alongside this, a specific first-line pharmacological agent — a laxative therapy — is titrated to a defined stool-frequency endpoint. Structured nutritional therapy is started without delay, addressing both energy and protein requirements.

The full protocol — including the complete treatment algorithm, specific agents, titration guidance, and nutritional targets — is available in the structured evidence-based regimen.