This condition is temporary or permanent damage to the brain. The most common cause is an illness or condition that affects the liver. Toxins build up in the bloodstream because the liver is not working normally.

Normal Oxygen Flow to Brain

oxygen brain lungs
An interruption of this flow can lead to metabolic encephalopathy.
© 2009 Nucleus Medical Art, Inc.


Metabolic encephalopathy is caused by:

Risk Factors

These factors increase your chance of developing metabolic encephalopathy:

Tell your doctor if you have any of these risk factors.

If you have liver problems, the risk of metabolic encephalopathy is increased by:

  • Low oxygen levels in the blood
  • Infections
  • Major surgery
  • Any serious illness that causes changes in the body’s chemical make-up or metabolism
  • Use of certain medicines, such as sedatives and narcotics
  • Bleeding within the intestines
  • Persistent vomiting or diarrhea that lowers blood potassium levels

The following toxic overdoses can also increase your risk of the condition:


Symptoms include:

  • Confusion or agitation
  • Changes in behavior and personality
  • Forgetfulness
  • Disorientation
  • Insomnia
  • Muscle stiffness or rigidity
  • Tremor (particularly a flapping tremor of the hands)
  • Difficulty speaking
  • Asterixis (rapid momentary loss of tone in the muscles)
  • Uncontrollable movements or seizures (rare)
  • Stupor or coma

These problems can develop quickly. They may resolve when the condition is reversed. However, prompt treatment is needed before a coma occurs.


This condition is very serious. It can quickly become an emergency. You will need to be hospitalized. Doctors will do an exam to assess your neurological condition.

The following tests may be done:

  • Blood tests—usually show high blood ammonia levels and other abnormalities related to the failing liver
  • Electroencephalogram (EEG)—may be used to determine how the brain has been affected
  • Imaging studies of the brain ( CT scan or MRI )—may be done to evaluate other causes


Hospitalization and Emergency Care

In the hospital, the staff will treat the problems that caused the condition. They will try to remove or neutralize toxins that have built up in the bloodstream. The goal is to reverse the underlying condition. But, brain injury can still occur. In some cases, brain injury is permanent.


Medications may be used to:

  • Neutralize toxins
  • Treat the condition

Dietary Restrictions

You may need to eat a low-protein diet to help lower blood ammonia levels. (The body creates ammonia when it metabolizes and uses protein.) You may have other changes in your diet.

Tube feeding and life support may be needed, especially in the case of coma.


If this condition is due to organ failure, you may need a transplant .


To help reduce your chance of getting this condition, take the following steps:

  • Get early treatment for liver problems. If you have liver problems and any of the above symptoms, call your doctor right away.
  • If you have a disease (such as cirrhosis), see your doctor regularly.
  • Avoid overdosing. Avoid being exposed to poisons or toxins.