I am writing as the wife of a patient currently in bed sleeping due to another bout of toxin overload .
With ulcerative colitis and liver failure currently from psc he is on the list for his second transplant lactulose is needed full time but this makes his colitis worse , bowels are already open very frequently indeed, so lactulose is very hard to tolerate regularly .
Does anybody else or any carers experience this ? it all makes me very nervous 
And what point do we go to hospital with Hepatic Encephalopathy ? is there a marker of severity ? ,
Thank you in advance
If he's sleeping more than waking it's probably time for hospital - in light of the fact he's awaiting transplant i'd be contacting transplant co-ordinators as there may be a need for him to be admitted and perhaps be bumped up the list.
Is he on Rifaximin in combination with the lactulose?
Katie
thankyou Katie for your reply .
He is in rifaxamin too , I was getting concerned as wasnt stirring but promoted him sit and eat , which he did he is now up and more with it !
Was just about to call the hospital but 🤞he just needed the rest . Such a worry for us carers trying to get the balance right .
Thanks again katie
BLT guidance on HE at :- britishlivertrust.org.uk/in...
What's the difference between HE and cerebellar ataxia?
Cerebellar ataxia is a violation of coordination due to a pathological process in the cerebellum. The clinical symptoms of HE may be similar to cerebellar ataxia in some cases. It is important to establish the presence of chronic progressive liver disease for the correct interpretation of HE. Testing for ammonia in the blood can help but it's not always informative unfortunately.
Ataxia usually results from damage to the part of the brain that controls muscle coordination (cerebellum) or its connections. Many conditions can cause ataxia, including alcohol misuse, stroke, tumor, brain degeneration, multiple sclerosis, certain medications and genetic disorders.
Whereas, Hepatic Encephalopathy is brain changes as a result of toxin build up due to the liver being damaged and not functioning properly.
Hepatic encephalopathy
Hepatic encephalopathy 
Hepatic encephalopathy reoccurrence 
Episode of Hepatic Encephalopathy 
