Hepatic Encephalopathy

Question 1

What is hepatic encephalopathy?

Answer 1

A reversible syndrome of brain dysfn caused by liver insufficiency and/or portal system shunting. It is often a complication of Cirrhosis -> blood shunted away from liver -> NH3 in nonfiltered blood builds up -> neuro and systemic symp

Question 2

What is decerebrate posturing?

Answer 2

Supine, palms out contractions

Question 3

WU for Hepatic Encephalopathy?

Answer 3

• Head CT W/O Contrast to r/o other ET of mental status change
• Psychometric Tests - # Connection Test (Reitan Test)

Question 4

What type of IV fluids do you order for Hepatic Encephalopathy?

Answer 4

Lactated Ringers

Question 5

How do you lower their blood ammonia to reverse hepatic encephalopathy?

Answer 5

Give Ammonium Detoxican (Lactulose)
MOA: bac degradation of lactose creates an acidic pH -> inhibits diffusion of NH3 into blood

Question 6

A 70yo man with known hepatitis presents with confusion, jaundice, decerebrate posturing, slurred speach, and abnormal reflexes. What labs should you order?

Answer 6

Fasting gluc (bedside)
CBC W/diff
CMP
PT/PTT/INR
LFTs
NH3
UA
EKG
TSH/Free T4

r/o everything under the sun
Hepatic Encephalopathy is a Dx of EXCLUSION