With cirrhosis, the liver can no longer metabolize properly the ammonia from protein foods. That ammonia goes through the blood system and ends up in the brain and manifests itself in hepatic encephalopathy which has many adverse symptoms. I can no longer drive a car because of hepatic encephalopathy incidents that have me confused and unable to function properly. There is a thing referred to as "brain fog" also that is caused by the ammonia and ensueing hepatic (related to liver) encephalopathy (the proper name for the symptoms of HE).

WilburTheCat has perhaps the most profound history with hepatic encephalopathy and I am sure if you refer back to past postings, you can see that he had a serious episode of HE inwhich he has limited memory of having done things such as climb a ladder to the roof as well as many other's who have had episodes inwhich they cannot differentiate left from right. Each person's level of HE(the ammonia from unmetobalized protein) varies. Some cause very severe episodes and some, come and go with only slight evidence of it's existence.

There is a medication (or at least the only one I have experience with) called Lactulose which metabolizes the ammonia in protein foods before it goes to the liver and on through the body eventually ending in the brain. This is an organic, sickening sweet "laxative" that helps the ammonia pass through the system without going to the brain. It, of course, has unpleasant side effects such as ongoing loose stool, flatulence and in some people, a feeling of nausea. I have taken it twice a day for a couple of years now and have very limited episodes of HE from ammonia in protein since beginning to regularly take it.

The usuall protocol is to limit protein foods to some degree however, protein in foods is what the body relies on to regenerate muscle so, when you limit protein in the diet for a prolonged time, you can experience some muscle wasting. It is a necessary part of good nutrition and the best that can be done is for the ammonia to be expelled without going through the system to the brain.

It is not a pleasant experience and, like I said, serious enough for me to have my doctor to have stopped me from driving a car. I feel that the unpleasantness of the Lactulose side effects are off set by the fact that I have few episodes of HE and limited in duration and severity. So, it is worth it to me. Some people would rather not take it at all choosing another type of medication.

I can't speak to the side effects of other medications used to treat HE because I have only experience with Lactulose.

I hope this has helped in some way. There are many side symptoms of cirrhosis and the severity and duration of each depends on the person because all people are different and react differently to medicines. The times I had ongoing side effects of HE were scary to me as I have limited recollection of what exactly I did or what I said while having the episode. It is a side effect of liver disease that should not be ignored.

It is best to keep a list of questions for your doctor to answer so each time you visit for routine blood work-ups, he/she can give you better insite as to what you can expect and what to take in the way of medication. Hugs and prayers.............CarolLentz

thank you so much carol that cleared up a lot of my questions, I'm going in for another blood test tomorrow

My doctor says not to worry about your ammonia count. He could tell how affected I am just by asking me to answer dumb questions that everyone knows and if I can't answer then I'm bad. I've had my number go up to 192 before and I was able to comprehend most of what was happening.

Ammonia levels are incredibly difficult to measure.

My GI doesn't even do them they are so unreliable.

The best test is just work with your GI, he'll ask questions, dates, past memories, etc. It's actually a more accurate measurement than the blood test.

Mentioned this before, but testing for ammonia involved putting the blood immediately on ice, transporting the blood, doing the testing, etc. all of which can highly skew the results.

There is an arterial blood test, much more accurate, but rarely ordered. I've never had it in seven years.

My docs rely on symptoms and memory/cognitive testing.

Lactulose is a major help and does clear up many of the symptoms, but it a very "physical" medication, be near a bathroom at all times.

For me, I don't truly know if it really helped, because I refused to take it, even trying to adjust the dosage, down to a 1/4 teaspoon seemed to be too much. It does help many people, so give it a try.

All the different meds affect us each differently, so don't take my bad experience as what may happen with you.

Carol has done very well, yet with me, doesn't agree with my body.

I'm fortunate that my ammonia levels have always been normal, so far. I sure get confused some times! But its not ammonia levels.

I'm always reading that it's better to consume plant protein rather than meat protein. Vegetables, beans, peas, whole grains, nuts.

Fish is a good thing too.

Marilyn, I switched to the fish diet about two weeks ago.

Mainly to lose some weight, trying to stick to just proteins and veggies.

My neighbor and I split a half beef last fall, so have tons of beef in the freezer, along with chickens and pork, so shouldn't have any problem sticking to the protein diet for quite a while.

Been buying fish about once a week and it's fantastic. Cooks quick, some odor, but keep the kitchen fan on and it all vanishes.

I've never had a problem with proteins. It seems each of us experience this disease differently.

Nice to see you post
God Bless You

I have had some HE episodes and when I feel them happening I take Xifaxan. It is an antibiotic that works in your gut to kill the bacteria that your liver doesn't filter. No diarrhea and it seems to work.
What always trips me up is when I don't recognize it happening to me. Lots of near accidents in the car. Problems cooking, etc.. Sometimes the HE just creeps in like a fog and envelopes your brain before you know it.

And my doctor never checks ammonia level. Too hard to test and many people have normal ammonia levels and are definitely having HE.

I'm stage 3 cirrhosis with hep c, my G I doc sent me home and told me to call if I needed anything, they don't care if they can't make money off of us, my family doc is the one who tests my blood every 3 to 6 months for me, I've givin up on doctors, don't trust them to begin with

My doctor first noticed that my muscles were breaking down more than normal for my age. I told him I was eating fruits and veggies and chicken and fish but no other meat protein. He said I should start consuming some red meat (lean beef and pork) which I did and it was then that I had my first problem with HE. I didn't know what was happening but found out soon enough.

Like Wilbur said, the lactulose causes some pretty unpleasant side effects and many opt not to take it. Hugs and prayers.,.,.,.,.,.,.,.,.,.,.,CarolLentz

I have not had red meat in almost 2 years. And, no fish or chicken for the past 5 or 6 months but still have episodes of HE. Since I do not get protein from any kind of meat... I do not understand why I still have so many episodes of HE. Now... I can tell when it is beginning... so, I am hoping I will "realize" it in time to take extra Lactulose. Personally... I do not have a problem with taking it... put in my coffee instead of sugar in morning... and mix with vitamin water the other 2 times I take it. It gives me terrible awful cramping... but... I guess better to have cramps then to not know what is going on.