METABOLIC ENCEPHALOPATHY

METABOLIC ENCEPHALOPATHY

Definitions:

an acute confusional condition characterized by altered levels of consciousness

Criteria

• Coming to the emergency room with complaints of delirium or coma, acute or subacute onset, with no previous history of an obvious cause.
• The condition is reversible if treated promptly, but also can lead to death.
• Disease with characteristic clinical or laboratory results that strongly support a particular diagnosis.
• Cases are rare and are often not detected by the physician who will make a diagnosis and begin treatment

Risk Factors

- Patients with multisystem disease

- Using psychoactive drugs

- Old age

- Malnutrition

Etiology

• Anoxia or ischemia

• Hypoglycemia

• Nutrition

• Hepatic Encephalopathy

• Uremia or dialysis

• Pulmonary Disease

• Endocrine disorders (including diabetes)

• drug poisoning

• ion and acid-base disorders

• temperature regulation

• Commas mixed or nonspecific metabolic

Clinical Picture

• Clinical signs vary depending on the cause
• A careful examination and careful about the level of consciousness, respiratory pattern, pupillary reaction, ocular movements, motor function
• An EEG may help in differentiating metabolic encephalopathy with psychiatric disorders and differentiate supratentorial to infratentorial structural lesions.
• In patients with metabolic encephalopathy, loss of consciousness often start with the first sign of delirium and often arousal disorder (can be increased or decreased).
• Deficit move, tremor, myoclonus, asterixis
• Pupillary reflex either (except barbiturate poisoning, anticholinergics, opioids)

Differential Diagnosis Based BGA

Metabolic coma: Diagnosis appeal based on acid-base abnormalities

Respiratory Acidosis

Sedative drug intoxication

pulmonary encephalopathy

Respiratory Alkalosis

hepatic encephalopathy

salicylate intoxication

sepsis

Metabolic Acidosis

diabetic ketoacidosis

uremic encephalopathy

lactic acidosis

intoxication Paraldehyde

methanol intoxication

Ethylene glycol intoxication

isoniazid intoxication

salicylate intoxication

Sepsis (terminal)

Metabolic Alkalosis

Commas are not uncommon

Examination

- Similar to the case of coma

- Avoid the use of sedative drugs

Preliminary Therapy

• Focus on the causes of disease and therapy

   - Immediately treat the cause quickly

     1. Wernicke's encephalopathy: thiamine, glucose

     2. Opiate poisoning: naloxone

     3. Benzodiazepine poisoning: flumazenil

   - Modification of environmental factors

     1. Avoid sleep disorders

     2. Place the comfortable indoor circulation

     3. Perform rigorous observation

• Treatment of symptomatic

   - Determine the purpose of therapy (reducing the 

      risk of injury, reduce tachycardia, patient comfort)

   - Haldol: po / iv / im with a low dose

     1. extrapyramidal side effects

     2. It takes 10 minutes

     3. In fact worsen the condition of patients with alcohol

         withdrawal or cocaine intoxication. In this case 

         the choice of benzodiazepine therapy.

• Avoid using sedatives. If the patient is likely to hurt 

  themselves, can be administered midazolam