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ENCEPHALOPATHY
Dr. Reena
Residant Ward 6
Definition
• It is a state of disordered CNS function, resulting from
failure of liver to detoxify toxic agents because of hepatic
insufficiency and porto-systemic shunt.
• Other factors:
Appearance of
Increased in blood abnormal amines in
NH3 etc systemic circulation
Interference with
Toxic effect on neurotransmission
brain
Endotoxins
• Ammonia.
• Mercaptans (degradation of methionine in the gut)
• Phenols.
• Free fatty acids.
• Gamma amino butyric acid(GABA)
• Octopamine.
Causes
• Hypokalemia.
• Alkalosis.
• Hypoxia.
• Hyponatremic.
Precipitating Agents
• (D) Drugs
• Diuretics.
• Narcotics, Tranquilizers, Sedatives.
Clinical Features
•A Disturbance in consciousness
• Disturbances in sleep rhythm.
• Impaired memory/ apraxia.
• Mental confusion.
• Apathy.
• Drowsiness / Somnolence.
• Coma.
• B. Changes Personality
• Childish behavior.
• May be aggressive out burst.
• Euphoric.
• Foetor hepaticus – Foul–smelling breath associated
with liver disease due to mercaptans.
• C Neurological signs:
• Flapping tremor / Asterixis (in pre coma).
• Exaggerated tendon reflex.
• Extensor plantar reflex.
Clinical Staging
Investigation
• Diagnosis is usually made clinically
• EEG (Electroencephalogram)
• Subdural Haematoma.
• Drug or Alcohol intoxication.
• Wernicke’s encephalopathy.
• Hypoglycaemia.
Management
• Supportive Treatment.
• Rifaximin
• L-ornithine-L-aspartate
• 9 g orally thrice a day.
• L-acyl-carnitine aspartate
• 4 g orally daily.
• Zinc sulphate
• 600mg/day in divided doses.
Correct amino acid metabolic
imbalance
• Infusion or oral administration of BCAA
(branched-chain amino acid)
• Other Therapies: