What are the symptoms of hepatic coma?
Jun 26, 2025
Source: Cainiu Health
Dr. Gao Jun
Introduction
Under normal circumstances, hepatic coma, also known as hepatic encephalopathy, is a central nervous system dysfunction syndrome based on metabolic disorders caused by severe liver disease. Its symptoms include disturbed consciousness, abnormal behavior, asterixis, speech disorders, and neurological signs. If coma deepens or vital signs become unstable, emergency intervention is required to reduce mortality.
Generally, hepatic coma, also known as hepatic encephalopathy, is a syndrome of central nervous system dysfunction based on metabolic disturbances caused by severe liver disease. Its symptoms include consciousness disturbance, behavioral abnormalities, asterixis, speech disorders, and neurological signs. A detailed analysis is as follows:
1. Consciousness disturbance
Progressive worsening from drowsiness and delayed reaction to somnolence and coma. Due to loss of the liver's detoxification function, toxic substances such as ammonia accumulate, inhibiting the central nervous system. Early manifestations include daytime sleepiness and nighttime excitement; later stages may develop into a coma unresponsive to verbal stimuli.
2. Behavioral abnormalities
Changes in personality and abnormal behavior may occur. Brain dysfunction leads to disturbances in higher neural activities; some patients may exhibit psychiatric-like symptoms such as hallucinations and delusions.
3. Asterixis
Rapid flexion and extension, or shaking of the fingers when both hands are held outstretched, resembling the flapping of bird wings. This is a characteristic sign of hepatic encephalopathy caused by extrapyramidal system involvement and abnormal limb muscle tone.
4. Speech disorders
Manifested as slurred speech, disorganized logic, and even inability to understand others' speech. Toxins such as ammonia affect the language centers in the cerebral cortex, leading to decreased thinking and expressive abilities.
5. Neurological signs
Increased muscle tone and hyperactive tendon reflexes may occur; severe cases may present with pathological signs such as a positive Babinski sign. In advanced stages, widespread brain dysfunction may lead to ominous signs such as altered pupil responses and abnormal respiratory rhythms.
Precipitating factors of hepatic encephalopathy are often associated with upper gastrointestinal bleeding, infection, electrolyte disturbances, or excessive protein intake. The severity of symptoms is closely related to liver function impairment and blood ammonia levels. If coma deepens or vital signs become unstable, emergency intervention is required to reduce mortality.
