Table 4.

Diagnostic tests to identify the precipitating factors of hepatic encephalopathy and their treatments

Precipitating factor	Diagnostic tests	Treatments
Gastrointestinal bleeding	Endoscopy, complete blood count, digital rectal examination, stool blood test	Transfusion, treatment through endoscopy or interventional radiology, vasoactive drugs
Infection	Complete blood count (white blood cell differential count), C-reactive protein, chest X-ray, urinalysis and urine culture, blood culture, diagnostic paracentesis	Antibiotics
Constipation	History-taking, abdominal x-ray	Enema or laxatives
Excessive protein intake	History-taking	Limiting protein intake
Dehydration	Skin elasticity, blood pressure, pulse rate	Stop or reduce diuretics, fluid therapy (e.g., intravenous albumin infusion)
Renal dysfunction	Serum urea nitrogen, serum creatinine, serum cystatin C, serum electrolyte	Stop or reduce diuretics, fluid therapy (e.g., intravenous albumin infusion)
Hyponatremia	Serum sodium concentration	Stop or reduce diuretics, fluid restriction
Hypokalemia	Serum potassium concentration	Stop or reduce diuretics
Benzodiazepine	History-taking	Stop benzodiazepine, flumazenil
Opioids	History-taking	Stop opioids, naloxone
Acute liver dysfunction	Liver function test, prothrombin time	Conservative treatment, liver transplantation