(Coma, Hepatic; Hepatic Coma; Hepatic Encephalopathy; Portal-Systemic Encephalopathy)
Pronounced: MET-a-bol-ik En-SEF-a-lo-PATH-ee
This condition is temporary or permanent damage to the brain. The most common cause is an illness or condition that affects the liver. Toxins build up in the bloodstream because the liver is not working normally.
Normal Oxygen Flow to Brain
Metabolic encephalopathy is caused by:
These factors increase your chance of developing metabolic encephalopathy:
- Acute renal failure]]> (renal disease)
- ]]>Vitamin B1]]> deficiency
- ]]>Hyperosmolar hyperglycemic crisis]]>
- Metabolic acidosis
- ]]>Hashimoto's thyroiditis]]>
- ]]>Acute adrenocortical insufficiency]]>
- Previous history of brain injury (eg, ]]>tumor]]> , ]]>stroke]]> )
Tell your doctor if you have any of these risk factors.
If you have liver problems, the risk of metabolic encephalopathy is increased by:
- Low oxygen levels in the blood
- Major surgery
- Any serious illness that causes changes in the body’s chemical make-up or metabolism
- Use of certain medicines, such as sedatives and ]]>narcotics]]>
- Bleeding within the intestines
- Persistent vomiting or ]]>diarrhea]]> that lowers blood potassium levels
The following toxic overdoses can also increase your risk of the condition:
- Confusion or agitation
- Changes in behavior and personality
- Muscle stiffness or rigidity
- ]]>Tremor]]> (particularly a flapping tremor of the hands)
- Difficulty speaking
- Asterixis (rapid momentary loss of tone in the muscles)
- Uncontrollable movements or ]]>seizures]]> (rare)
- Stupor or ]]>coma]]>
These problems can develop quickly. They may resolve when the condition is reversed. However, prompt treatment is needed before a coma occurs.
This condition is very serious. It can quickly become an emergency. You will need to be hospitalized. Doctors will do an exam to assess your neurological condition.
The following tests may be done:
Hospitalization and Emergency Care
In the hospital, the staff will treat the problems that caused the condition. They will try to remove or neutralize toxins that have built up in the bloodstream. The goal is to reverse the underlying condition. But, brain injury can still occur. In some cases, brain injury is permanent.
Medications may be used to:
- Neutralize toxins
- Treat the condition
You may need to eat a low-protein diet]]> to help lower blood ammonia levels. (The body creates ammonia when it metabolizes and uses protein.) You may have other changes in your diet.
Tube feeding and life support may be needed, especially in the case of coma.
If this condition is due to organ failure, you may need a ]]>transplant]]> .
To help reduce your chance of getting this condition, take the following steps:
- Get early treatment for liver problems. If you have liver problems and any of the above symptoms, call your doctor right away.
- If you have a disease (such as cirrhosis), see your doctor regularly.
- Avoid overdosing. Avoid being exposed to poisons or toxins.
National Digestive Diseases Information Clearinghouse
National Institute of Neurological Disorders and Stroke
Canadian Liver Foundation
Bernuau J. Acute liver failure: avoidance of deleterious co-factors and early specific medical therapy for the liver are better than late intensive care for the brain (review). J Hepatol . 2004;41:152-155.
Butterworth RF. Role of circulating neurotoxins in the pathogenesis of hepatic encephalopathy: potential for improvement following their removal by liver assist devices. Liver Int . 2003;23(suppl 3):5-9. Review.
Hepatic encephalopathy. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated April 2008. Accessed July 28, 2008.
Juretschke L. Kernicterus: still a concern. Neonatal Netw . 2005;24:7-9.
Lizardi-Cervera J, Almeda P, Guevara L, et al. Hepatic encephalopathy: a review. Ann Hepatol . 2003;2:122-130. Review.
Siegal GJ, Agranoff BW, Albers RW, Uhler MD. Metabolic encephalopathies. In: Basic Neurochemistry: Molecular, Cellular, and Medical Aspects. 6th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 1999.
Toftengi F, Larsen F. Management of patients with fulminant hepatic failure and brain edema. Metab Brain Dis . 2004;19:207-214.
Last reviewed January 2009 by ]]>Rimas Lukas, MD]]>
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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