 Hepatic encephalopathy HE is broadly defined as an alteration in mental status and cognitive function occurring in presence of liver failure. The clinical picture of HE arises as a complication of chronic and, more rarely, acute liver disease. HE occurs in up to 70 of patients with cirrhosis at some time during the course of their disease 1,2. It is characterized by personality changes, intellectual impairment and a depressed level of consciousness. HE may be clinical unapparent minimal HE detected by abnormal neuropsychometric or neurophysiological tests 3. The common presentation is overt HE which occurs in patients with advanced cirrhosis with portal-systemic collateral circulation. Episodes of HE in patients with cirrhosis are induced by precipitating factors, like dehydration, hypokalemia, large protein intake, gastrointestinal bleeding, constipation, infections, use of psychotropic drugs, alcohol intake or acute liver injury hepatitis. 