Hallucinations with Hepatic Encephalopathy

A build up of toxins in the brain can lead to confusion, memory and mood changes, depression, and even delusions. Psychotic episodes and hallucinations with hepatic encephalopathy (HE) can be some of the worst things a person with end stage liver disease (ESLD) can have. If you or someone you love is dealing with this, it takes a great amount of patience and encouragement. With help, they can get the right meds and try to reverse the effects.

Downward Spiral

Depression – HE can start as depression. After telling my doctor I didn’t have the energy to decorate for Christmas, he put me on an anti-depressant. Well, that turned my reverse sleep pattern into insomnia. At bedtime, I took Ambien and xanax. I also hired someone to put up the tree. 

Confusion – This was tough to pin down. At first, I traveled all day, scheduling the harder things in the morning while chugging caffeine. After lunch, I often slept in my car for an hour. Eventually, I went back to the classroom teaching high school and college. I was good at my job, and my students did well on state test scores. All of my work related goals were met, but I was on autopilot.

Mood Changes – At home, I locked myself in the bathroom and cried myself to sleep. I didn’t know what was wrong, and sleep was my best friend. On a few occasions, I became belligerent and threw the remote control across the room when the noise of the television was too much for me. The Ambien probably stayed in my blood stream 24/7.

Who’s That Girl?

Memory – I took my Franklin Covey planner everywhere. It was my brain. Inside my own head was a swirl of mush, and I have only spotty remembrances of the last 18 months before my liver failed. Many times I came home from a big box store with no purchases. Other times, I had the whole trunk of my car filled and didn’t remember buying it.

Hallucinations – I was wandering around in a dream and even went outside at night chasing armadillos with a flashlight. I was convinced the critters were eating my flowers. In one of my hallucinations with HE, I even transplanted weeds from a field into my flower beds, trying to lure armadillos to eat them. I thought my mother was trying to give me secret messages and talked of it constantly. I’ve heard of people who accused their family of trying to poison them with lactulose or xifaxin.

Psychosis – I woke up countless times on the side of a highway shaking and thinking that there were wolves in the woods that would attack my car. I was too sick and foggy to drive, and actually had 3 wrecks within 6 months. My insurance cost more than a 16 year old kid with a DUI. But I kept going.

Delusional – I was in my late 40s and early 50s, so I had physical strength and could act “normal” in most conversations. I grew quieter though, afraid of sounding kooky, or just plain so zoned out that I had nothing to say. Many people have shared sad stories about a family member attacking them. Others say they sit and have constant arguments and bickering during and HE episode. 

Hallucinations with Hepatic Encephalopathy

Here’s some good news: Getting the right treatment can help to reverse all these symptoms. Finally my liver and kidney failed. I woke up after getting a blood transfusion. After the ascites was drained, and I started taking Lactulose, the fog began to lift even more. My family began to understand the meaning of brain fog from HE. I hope this helps you and your family understand how hallucinations with hepatic encephalopathy are treatable. With All my Love, Karen