Vet Neurology Guide 2025: Hepatic Encephalopathy in Dogs and Cats — Symptoms, Testing & Emergency Care
In this article
🧠 Vet Neurology Guide 2025: Hepatic Encephalopathy in Dogs and Cats — Symptoms, Testing & Emergency Care
When the liver fails, the brain suffers. Hepatic encephalopathy is a serious neurological condition seen in pets with liver disease, and in many cases, it’s an emergency. I’m Dr Duncan Houston BVSc, and in this detailed 2025 guide, I’ll help you understand what hepatic encephalopathy is, how to recognize early signs, and what can be done to treat and prevent it. 🐶🐱
1. What Is Hepatic Encephalopathy?
Hepatic encephalopathy is a neurological disorder caused by the buildup of toxins (especially ammonia) in the blood when the liver is no longer able to filter them out. These toxins interfere with normal brain function. 🧪
This condition most commonly affects dogs, but cats can also develop it, particularly those with hepatic lipidosis or other forms of liver dysfunction. 🧠💥
2. Causes of Hepatic Encephalopathy
- 🔁 Portosystemic shunt: Abnormal blood vessel bypasses liver filtering (often congenital)
- 🧈 Hepatic lipidosis: Fat buildup in liver cells (especially in cats)
- 🦠 Chronic hepatitis or cirrhosis
- 🧬 Infections, toxins, or liver tumors
- 🍖 High protein diet: Can worsen ammonia buildup
3. Symptoms of Hepatic Encephalopathy
The signs may vary depending on the severity of liver dysfunction and the degree of toxin buildup:
- 😵 Disorientation or altered mental state
- 🐾 Wobbly walking or incoordination (ataxia)
- 🧠 Seizures or twitching
- 🐕 Head pressing or circling
- 🗣️ Unusual vocalizations (crying, whining)
- 💤 Lethargy or coma (in severe cases)
- 👅 Drooling or nausea
- 🟡 Jaundice (yellow skin, gums, or eyes)
- 🩸 Vomiting or diarrhea
🚨 Symptoms often worsen after eating, as digestion releases more ammonia into the bloodstream.
4. Diagnosis of Hepatic Encephalopathy
To diagnose hepatic encephalopathy, your veterinarian will use a combination of tests:
4.1 Physical Exam
- 🔍 Neurological assessment
- 🩺 Check for jaundice, weight loss, abdominal swelling
4.2 Bloodwork
- 🧬 Elevated liver enzymes (ALT, ALP, bilirubin)
- 💉 Low blood sugar (hypoglycemia)
- 🩸 Anemia or clotting problems
4.3 Bile Acid or Ammonia Tests
- 🧪 Bile acid test: Assesses liver function
- 💨 Ammonia test: Measures toxin levels in the bloodstream
4.4 Imaging
- 🩻 Abdominal ultrasound: Looks for portosystemic shunt, liver size, or abnormalities
- 🧪 Additional diagnostics: X-rays, CT, or liver biopsy if needed
5. Emergency Treatment Options
When hepatic encephalopathy is diagnosed, immediate stabilization may include:
- 🧴 Lactulose: Reduces ammonia absorption from the gut
- 💊 Antibiotics: Reduce gut bacteria that produce ammonia
- 💉 IV fluids: Correct dehydration and support organ function
- 🧠 Anticonvulsants: Diazepam, levetiracetam, or phenobarbital for seizures
- 🛌 Hospitalization for monitoring and brain swelling management
Supportive Care May Include:
- 🥩 Low protein diet: Especially important in dogs with portosystemic shunts
- 🧫 Liver-protective agents: SAMe, silymarin (Denamarin®)
- 🧬 Vitamin and mineral supplements for liver support
6. Long-Term Management
If hepatic encephalopathy is caused by a treatable condition like a shunt, surgery may be recommended. In chronic cases:
- ⚕️ Medication to manage symptoms and lower ammonia
- 🍽️ Long-term diet management
- 🩺 Regular bloodwork and checkups
7. Can Pets Recover? 🐾
✅ Yes, if treated early and the liver disease is controlled.
- Mild cases can recover completely
- Moderate to severe cases can stabilize with intensive care and long-term management
- Severe or recurrent cases may result in permanent neurological damage or death
8. When to Call Your Vet
- 🧠 Behavior changes, especially after meals
- 🐕 Seizures, tremors, or collapse
- 🥱 Lethargy or confusion
- 🩺 Vomiting or jaundice
Don’t wait. Early intervention can save your pet’s life.
9. Ask A Vet: Liver & Neurology Help
Concerned about liver disease or neurological changes in your pet? Connect with licensed vets 24/7 through Ask A Vet. We help assess symptoms, review test results, and guide you through urgent care or diet changes. 🐶📱
10. Summary Table
| Condition | Recommended Care |
|---|---|
| Mild hepatic encephalopathy | Lactulose, low protein diet, liver supplements |
| Severe symptoms (seizures, coma) | Hospitalization, IV meds, brain swelling treatment |
| Underlying shunt or lipidosis | Surgery, long-term management, follow-up labs |
11. Final Thoughts
Hepatic encephalopathy is a frightening but treatable condition. By recognizing the early signs, acting quickly, and supporting liver health long-term, many pets can return to a comfortable, happy life. 🧠💙
— Dr Duncan Houston BVSc
Need personalized liver care advice? Visit AskAVet.com or download the app for expert help on testing, medications, and more. 💙
