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Suffering from Cirrhosis and HE, hallucinating vividly and mood swings. Suggestion?

My Father has advanced Cirrhosis and from the description of symptoms he also has HE. He is a big guy - 200lbs 6 and he is shouting and confused, hallucinating vividly, trying to get up from bed, angry, his hands, legs and feet shake. He has moments of lucidity. After eating just a few bites of food for 8 days he gorged on food yesterday and couldn t get enough. He has constant mood swings. He is going into a Hospice facility today, but we are worried he will be too much for the staff to handle the way he is. Is there any guideline for how long someone can experience these severe symptoms of HE before ammonia levels increase and he goes into a coma?
Asked On : Sun, 10 Mar 2013
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Critical Care Specialist 's  Response
Welcome to health care magic
Dear patient's son, developement of hepatic encephalopathy in a patient of cirrhosis of liver is called decompensation of cirrhosis and it can occur due to variety of reasons like infection e.g spontaneous bacterial peritonitis, pneumonia etc; upper GI bleeding; diuretics leading to hypokalemia; renal failure; portocaval shunting; constipation etc. What ever is the precipitating factor,all of these lead to accumulation of ammonia and other amines and chemicals in the blood that when enter the brain lead to encephalopathy. If these patients are properly treated in ICU along with the treatement of precipitating factors, a good majority of patients improve and come out of encephalopathy and others who don't improve land into coma and there is no test by which you can predict who are going to go into come and if the go in to coma then after how much of time will they go into come , although it generally happens over a period of few overs to few days.
Hope your father improves and wish him speedy recovery
Dr Arshad
Answered: Mon, 11 Mar 2013
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