Drug treatment of encephalopathy associated with fulminant liver failure

Hepatic encephalopathy is a complex neuropsychiatric syndrome that may comp licate either chronic or acute liver failure. Hepatic encephalopathy associ ated with fulminant liver failure is characterised by the development of ce rebral oedema and intracranial hypertension, and has a poor outcome in seve re cases if liver transplantation is not performed. Medical management of h epatic encephalopathy in fulminant liver failure is essentially directed to ward the prevention and treatment of cerebral oedema and intracranial hyper tension. Mannitol infusion should remain the main pharmacological treatment of cerebral oedema. Despite a lack of randomised clinical trial data, thio pental (thiopentone) has been widely accepted as an effective means of trea ting intracranial hypertension when mannitol fails. Acetylcysteine seems to have a beneficial effect by improving the cerebral blood flow and the cere bral metabolic rate for oxygen. The effectiveness of lactulose is well esta blished in chronic hepatic encephalopathy but not in fulminant Liver failur e. As the precise pathogenesis of hepatic encephalopathy in patients with f ulminant liver failure is unknown, there is no specific treatment of this s yndrome. In spite of a large number of published articles on the treatment of hepatic encephalopathy, only a few randomised, controlled studies are av ailable. Indeed, except for the rare cases in which treatment of the underl ying cause of disease is possible, the treatment of patients with fulminant liver failure is currently emergency liver transplantation.