This protocol applies when an episode of overt hepatic encephalopathy persists despite a prior management step directed at identifying and correcting its precipitating causes. When that approach does not achieve recovery, escalation to specific anti-HE treatment is indicated.
The preceding step involved search for and correction of any precipitating factors — including constipation, gastrointestinal bleeding, infections, hyponatremia, and dehydration — together with rapid removal of blood from the gastrointestinal tract and measures to control progression of the underlying liver disease. The required outcome, recovery from the episode of overt hepatic encephalopathy, was not achieved. This unmet goal is the basis for moving to the next treatment line.
When general precipitating-factor management has not resolved the episode, specific pharmacological treatment targeting hepatic encephalopathy directly is the next step. The approach involves a particular class of agents — the full regimen, sequencing, and further details are available in the complete structured protocol.
DOI: 10.1016/j.jhep.2022.06.001