Can Liver Failure Cause Mental Confusion?

The inability of the liver to perform its normal metabolic function is called as liver failure. It may be acute or chronic liver failure, but recently a third form is defined which is identified as an acute-on-chronic liver failure. Acute on chronic liver failure is described as when someone with chronic liver disease develops sudden liver failure. It can be hereditary or initiated by a variety of factors such as viruses, drugs, toxins, obesity, alcohol and other disease. The end stage of damaged liver referred to as cirrhosis, which can lead to liver failure, a life-threatening condition.

Liver Cirrhosis Can Induce Cognitive Impairment Disorder

Hepatic encephalopathy is a well-known neuropsychiatric disorder which may develop with advancing liver insufficiency and helps define the differing clinical syndromes of liver failure. Acute liver failure (ALF) is defined by the presence of hepatic encephalopathy within 8-weeks of the initial liver insult, in the absence of chronic liver disease (e.g. cirrhosis). In its most advanced stages, it is associated with intracranial hypertension and possible death from brain herniation. In cirrhosis, hepatic encephalopathy typically occurs insidiously with wide-ranging neuropsychiatric disturbances such as psychomotor dysfunction, impaired memory, decreased reaction time, diminished attention, sensory abnormalities and poor concentration.

Can Liver Failure Cause Mental Confusion?

Can Liver Failure Cause Mental Confusion?

Mental confusion is associated liver failure. Clinically, hepatic encephalopathy can be described in four stages. The first stage is the mildest form of hepatic encephalopathy, which is challenging to distinguish clinically but can be proved with the help of neuropsychological testing. The signs and symptoms of 1st phase are amnesia, mild confusion, and bad temper. The first stage of hepatic encephalopathy is characterized by an abnormal sleep pattern i.e. day sleepiness and awake at night. The second stage is marked by lethargy and personality changes. The third stage is noticeable by worsened mental confusion. The fourth stage is marked by a progression to coma. One of the most devastating complications of hepatic encephalopathy is buildup of toxins in the brain. An injured liver by cirrhosis cannot remove toxins from the blood. These toxins can accumulate in the circulating system and cause mental confusion.

Hyperammonemia Can Slow The Mental Process and Cause Confusion

The increase in blood ammonia in advanced liver disease is a consequence of impaired liver function and of shunting of blood around the liver. In addition to direct neurotoxicity, low-grade astrocyte swelling may contribute to brain dysfunction. The enzyme glutamine synthetase which is present in the endoplasmic reticulum of astrocytes is responsible for the conversion of and ammonia to glutamine. As glutamine acts as an osmolyte, water moves inside the astrocyte causing low-grade cerebral edema and a predominantly neuroinhibitory state that is, slowing of mental processes is pathognomonic of hepatic encephalopathy, which is associated with the chronic liver disease.

Systemic Inflammatory Response Syndrome In Acute Liver Failure Cause Mental Confusion

The peripheral immune system communicates with the brain in response to infection and inflammation. The systemic inflammatory response syndrome results from the release and circulation of proinflammatory cytokines and mediators. Sepsis-associated encephalopathy is characterized by changes in mental status especially cause mental confusion. The systemic inflammatory response syndrome in the problem of acute liver failure, in this the cause of an infection is common.


One of the key tasks of the liver is to convert toxic substances in the body to harmless. During a liver failure, these “toxins” can accumulate in the circulatory system and affect the function of the nervous system. This condition occurs in hepatic encephalopathy, which may consequence in both physical and mental changes. Movement problems, changes in mood, irritability, memory impairment, fatigue, and mental confusion are observed in liver cirrhosis.

The best example is an elevated level of ammonia (hyperammonemia) in the brain can lead to cerebral dysfunction involving a spectrum of neuropsychiatric and neurological symptoms such as reduced memory, confusions, reduced attention, sleep-wake inversions, brain edema, intracranial hypertension, seizures, ataxia, and coma.

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Pramod Kerkar, M.D., FFARCSI, DA
Pramod Kerkar, M.D., FFARCSI, DA
Written, Edited or Reviewed By: Pramod Kerkar, M.D., FFARCSI, DA Pain Assist Inc. This article does not provide medical advice. See disclaimer
Last Modified On:November 14, 2018

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