A liver that is working poorly may not be able to get rid of toxic substances like ammonia (which comes from the intestines), and it may allow these substances to go into the brain and cause confusion. Besides confusion, toxins in the brain cause changes in your sleep, your mood, your concentration, and your memory. If it gets bad, these toxins can even cause sleepiness (in some cases, coma). These changes are all symptoms of hepatic encephalopathy. If you have encephalopathy, you may have problems driving, writing, and performing other activities of daily living. Signs of encephalopathy are trembling and hand “flapping.”

Encephalopathy may occur when you have an infection or when you have internal bleeding. It may also occur if you are constipated, take too many water pills, or take tranquilizers or sleeping pills. Your doctor might prescribe a medication called lactulose. Lactulose is a laxative syrup that makes your bowels move more often (up to two or three times a day) and helps get rid of ammonia. Your doctor might also prescribe rifaximin, an antibiotic.