Vet Guide 2025: Hepatic Encephalopathy in Dogs and Cats 🐶🐱🧠

Hello, devoted pet parents! I’m Dr Duncan Houston, your caring veterinarian. This comprehensive 2025 guide explores hepatic encephalopathy—a serious neurological condition linked to liver disease. From causes to care, you’ll get clear insights, treatment tips, home care advice, and recovery expectations. Let’s protect your beloved companions together! 😊

What Is Hepatic Encephalopathy?

Hepatic encephalopathy (HE) is a brain disorder arising when the liver can’t detoxify blood—allowing toxins like ammonia to reach the brain. This can lead to neurological symptoms, including seizures and coma.

Common Causes in Pets

• Portosystemic shunts: Abnormal blood vessels bypass the liver.
• Hepatic lipidosis: Fatty liver disease common in cats.
• Advanced chronic liver disease: Multiple causes including infection, cancer, and toxins.

Clinical Signs & Symptoms

• Unusual behavior changes—confusion, disorientation
• Wobbly gait or loss of coordination
• Seizures, vocalizing, drooling, blindness, weakness, or coma
• GI signs—vomiting, diarrhea, poor appetite, weight loss
• Signs of liver disease—jaundice, abdominal enlargement, excess drinking/urinating
• Symptoms often worsen after eating due to increased ammonia in the bloodstream

How Is It Diagnosed?

Physical & Neurological Exam

• Check for signs of both liver and neurological issues
• Assess coordination, vision, mental state, and neurological reflexes

Laboratory Tests

• CBC: May show anemia
• Biochemistry: Elevated liver enzymes (ALT, ALP, bilirubin) and low glucose
• Coagulation tests: Check for bleeding risk
• Bile acids and/or ammonia tests confirm impaired liver function

Imaging & Further Diagnostics

• Abdominal ultrasound to identify liver structure and shunts
• X-rays or CT for masses or inflammation
• Liver biopsy for definitive diagnosis if safe

Treating Hepatic Encephalopathy

Emergency Hospital Care

• Hospitalization for round-the-clock monitoring
• IV fluids to stabilize blood chemistry and hydration
• Anti-seizure medications (e.g., diazepam, levetiracetam, phenobarbital)
• IV drugs to reduce brain swelling, if present

Reducing Ammonia Production

• Lactulose: Traps ammonia in the gut to reduce absorption
• Non-absorbable antibiotics or enema to reduce ammonia-producing bacteria
• Dietary management—moderate protein to control ammonia load

Supporting Liver Health

• SAM‑e or Denamarin® to support liver function
• Treat underlying issues—e.g., surgical closure of shunts or treatment of lipidosis
• Monitor and treat complications like bleeding or infection

Long-Term Management

• Continue lactulose and/or antibiotics as needed
• Regular bloodwork to monitor liver enzymes and ammonia
• Adjust liver-supportive supplements over time
• Neurologic monitoring—watch for recurrence of signs

Prognosis: Can My Pet Recover?

Early and aggressive treatment often leads to recovery from neuro signs. However, ongoing liver health depends on the underlying cause. With successful management—especially surgical correction of shunts—relapse can be avoided, although some chronic cases may recur.

Home Care Tips 🏡

• Feed prescribed liver-supportive diets in small, frequent meals
• Ensure constant access to water
• Maintain calm, low-stress environment
• Keep follow-up appointments for bloodwork and imaging
• Monitor closely—report any behavior or neurological changes immediately

Frequently Asked Questions

Is hepatic encephalopathy painful?

The condition isn't painful per se, but secondary issues like swelling or infection can cause discomfort. Pain relief and supportive care help manage this.

Should I switch to a low-protein diet?

Some pets benefit from protein-controlled diets to reduce ammonia. Your vet will recommend if this is appropriate.

Is surgery always needed?

Surgery is ideal for congenital shunts, but not all cases are surgical. Medical management is key when surgery isn't feasible.

Can HE happen again?

Yes—especially if underlying disease isn't resolved. Continued monitoring and treatment reduce the chances of recurrence.

Can cats get hepatic encephalopathy?

Yes. Cats with liver disease—especially fatty liver—are susceptible and are treated similarly to dogs.

Conclusion

Hepatic encephalopathy is a serious but treatable condition when addressed early. With rapid hospitalization, supportive care, medication, and surgical correction when needed, many pets regain stable neurological function and quality of life.

Your ongoing vigilance—monitoring diet, symptoms, and follow-up tests—is critical to long-term well-being.

Need help? Visit Ask A Vet or download our app for personalized care plans, 24/7 vet access, and ongoing support tailored to your pet’s health journey. We’re here for you every step! 🐾📱

Dr Duncan Houston, BVSc