Acetyl-L-Carnitine In Severe Hepatic Encephalopathy

Inclusion Criteria: * patients with severe hepatic encephalopathy (grade 3 of the West Haven grading scale) with hepatic cirrhosis Exclusion Criteria: * Patients with a history of recent alcohol abuse, patients using psychotropic drugs (e.g., antipsychotics, interferon, benzodiazepines, anti-epileptics, sedatives and antidepressants) * Other exclusion criteria were the following: major complications of portal hypertension, such as gastrointestinal blood loss, hepatorenal syndrome or bacterial peritonitis; acute superimposed liver injury;patients with metabolic disorders such as diabetes mellitus, unbalanced heart failure and/or respiratory failure or end-stage renal disease; any additional precipitating factors such as high protein intake (additional high-protein meals), constipation; illiteracy.