The CSF is unremarkable except for mild protein elevation. Prognosis Encephalopathy in chronic liver disease usually responds to treatment, especially if the precipitating cause is reversible. In most cases, the syndrome regresses without permanent neurologic sequelae. Some patients, especially those with portacaval shunts, require continuous therapy, and irreversible extrapyramidal signs or spastic paraparesis rarely develops. This synthetic disaccharide syrup alters colonic pH and flora and also acts as an osmotic cathartic.
Parenteral antibiotics are usually ineffective.
Sedation deepens encephalopathy and should be avoided, even if the patient is agitated. Treating coma caused by fulminant hepatitis with high-dose corticosteroids or with exchange transfusion and other complex procedures designed to remove circulating toxins has not proved effective. Instead, meticulous nursing care and attention to associated complications give the best chance of survival. Deteriorating patients with fulminant liver failure should be promptly referred to a transplant center because emergency liver transplantation can be lifesaving.