What are West Haven grades of hepatic encephalopathy?

Grade 0: no symptoms (covert HE detectable by psychometric testing). Grade 1: trivial lack of awareness, euphoria/anxiety, shortened attention. Grade 2: lethargy, disorientation to time, obvious personality change. Grade 3: somnolence to semistupor, gross disorientation, bizarre behaviour. Grade 4: coma.

What triggers hepatic encephalopathy?

Common precipitants: GI bleeding (increased ammonia), infection (SBP, UTI), constipation, renal failure, sedative/diuretic use, dietary protein excess, hyponatraemia, hypokalaemia, alkalosis.

How is Grade 3-4 HE managed?

Airway protection (intubation if Grade 3-4). Lactulose 30 mL q1-2h until 2-3 soft stools/day. Rifaximin 550 mg BID for secondary prevention. Identify and treat precipitants. Consider TIPS evaluation for refractory HE.

Hepatic Encephalopathy West Haven Grade

Grade hepatic encephalopathy using West Haven criteria (Grades 0-4). Guides treatment intensity: Grade 1-2: lactulose; Grade 3-4: ICU, consider rifaximin.

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Hepatic Encephalopathy West Haven Grade

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Frequently Asked Questions

What are West Haven grades of hepatic encephalopathy?

What triggers hepatic encephalopathy?

How is Grade 3-4 HE managed?