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Finally, treatment of mHE remains a huge unmet need and a huge concerted effort is needed to better define this condition to allow the development of new therapies

2,15,18 Lactic acidosis is a manifestation of poor tissue perfusion and can be aggravated by inhibition of mitochondrial calcium entry leading to decreased pyruvate dehydrogenase activity.18,19 Other effects are bowel infarction and ileus.2,20-22 Pulmonary oedema23-26 (both cardiogenic and non-cardiogenic) might be caused by excessive fluid resuscitation and precapillary vasodilatation, resulting in increased transcapillary pressure

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The patient should be screened and referred to her physician when appropriate