Hepatic Encephalopathy Grades/Stages
West Haven Criteria. Defines criteria for the stages of hepatic encephalopathy.
When to Use
West Haven Criteria:
Changes in behavior with minimal change in level of consciousness+1
Gross disorientation, drowsiness, possibly asterixis, inappropriate behavior+2
Marked confusion, incoherent speech, sleeping most of the time but arousable to vocal stimuli+3
Comatose, unresponsive to pain; decorticate or decerebrate posturing+4
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- Lactulose is a standard treatment for hepatic encephalopathy
- Ammonia testing may be helpful diagnostically or trending levels
- There should always be consideration to other causes of altered mental status in these patients, as they are at high risk for comorbidities including bleeding, infection, drug interactions, and electrolyte disturbances.
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