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Hepatic Encephalopathy in Dogs

By: Dr. Arnold Plotnick

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Hepatic encephalopathy (HE) is a degenerative disease of the brain caused by severe hepatic insufficiency in advanced liver disease. It is characterized by abnormal mental status, an altered state of consciousness and impaired neurologic function.

The most common cause is a congenital abnormality present at birth called a portosystemic shunt. This is an anatomical defect that causes blood to be diverted around the liver instead of passing through the liver. The liver cannot detoxify the blood and the toxins reach the brain and cause the clinical syndrome. Patients with liver failure due to toxic or infectious causes can also exhibit signs of HE.

There is no age, sex, or breed predisposition for animals with toxic or infectious liver disease; however, animals with congenital portosystemic shunts are usually brought to the veterinarian within the first year of life.

What to Watch For

The clinical manifestations of HE can range from mild (unusual behavior) to severe (coma).

  • Hysteria
  • Unpredictable bouts of aggression
  • Staggering
  • Pacing
  • Compulsive circling
  • Pressing the head against a wall
  • Sudden apparent blindness
  • Tremors
  • Seizures
  • Coma-like state

    These unusual behavior changes are often more pronounced a short time after a meal.

    Also watch for:

  • Anorexia
  • Lethargy
  • Weight loss
  • Drinking a lot or urinating a lot
  • Nausea or hypersalivation (drooling)
  • Vomiting
  • Diarrhea


    Hepatic encephalopathy is a syndrome and not a disease itself. It is diagnosed by a combination of the patient's history, physical examination findings and laboratory data. These findings can support the presence of significant liver disease in an animal in which no other cause for the neurologic and behavioral signs can be identified. Tests that help make the diagnosis of severe liver disease and resultant HE include:

  • Complete blood count
  • Serum chemistry panel
  • Urinalysis
  • Blood clotting profile
  • Blood ammonia level or ammonia tolerance test
  • Bile acid test
  • Abdominal radiographs or special dye studies
  • Abdominal ultrasound
  • Liver biopsy
  • Transcolonic scintigraphy


  • Remove the predisposing cause, if possible
  • Antibiotics
  • Lactulose
  • Diet

    Home Care and Prevention

    When at home, administer proper diet and medications as prescribed. Watch your dog for any of the signs listed above.

    One can minimize exacerbations of clinical signs of HE by avoiding some predisposing factors:

  • Don't feed high protein meals
  • Avoid drugs that might induce gastrointestinal bleeding, such as aspirin
  • Avoid giving tranquilizers or sedatives for travel
  • Avoid organophosphate insecticides

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