Table 1

The clinical stages of hepatic encephalopathy

StageMental state
IMild confusion, euphoria or depression, decreased attention, slowing of ability to perform mental tasks, untidiness, slurred speech, irritability, reversal of sleep rhythm
IIDrowsiness, lethargy, gross deficits in ability to perform mental tasks, obvious personality changes, inappropriate behaviour, intermittent disorientation (usually for time), lack of sphincter control
IIISomnolent but rousable, unable to perform mental tasks, persistent disorientation with respect to time and/or place, amnesia, occasional fits of rage, speech present but incoherent, pronounced confusion
IVComa, with (IVA) or without (IVB) response to painful stimuli
  • From Adams and Foley13 with modifications.