Hepatic encephalopathy: Difference between revisions
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==Patient Information== | |||
[http://www.nlm.nih.gov/medlineplus/ency/article/000302.htm Hepatic Encephalopathy] (Medline Plus) | |||
==See Also== | ==See Also== | ||
Revision as of 21:16, 3 October 2013
Background
- Diagnosis of exclusion
- Due to accumulation of nitrogenous waste products normally metabolized by the liver
- Spectrum of illness ranges from chronic fatigue to acute lethargy
Causes
- Increase in nitrogenous waste
- GI bleed
- Protein load from large meal
- Decreased hepatic metabolism
- Liver disease
- Alcohol withdrawal
- Sepsis
Stages
- Stage I - General apathy
- Stage II - Lethargy, drowsiness, variable orientation, asterixis
- Stage III - Stupor with hyperreflexia, extensor plantar reflexes
- Stage IV - Coma
DDx
- Subdural hematoma
- Hypoglycemia
- Wernicke-Korsakoff syndrome
- Hyper/hyponatremia
- Benzodiazepine overdose (decreased hepatic clearance)
- Renal failure
- Sepsis
Treatment
- Lactulose 20mg PO or (300mL in 700cc H2O retention enema x30min)
- In colon degrades into lactic acid: acidic environment traps ammonia
- Also inhibits ammonia production in gut wall
Disposition
Discharge
- Stage I or II w/ known ecephalopathy and who is otherwise well
Patient Information
Hepatic Encephalopathy (Medline Plus)
See Also
Source
Tintinalli