Your Health - Metabolic Encephalopathy

Metabolic Encephalopathy

(Coma, Hepatic; Hepatic Coma; Hepatic Encephalopathy; Portal-Systemic Encephalopathy)

Pronounced: MET-a-bol-ik En-SEF-a-lo-PATH-ee

Definition

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

An interruption of this flow can lead to metabolic encephalopathy.

Causes

Metabolic encephalopathy is caused by:

Poisoning
Diseases (eg, cirrhosis , hepatitis , diabetes , heart disease , renal failure )
Medical conditions that cause blood circulation to bypass the liver

Risk Factors

These factors increase your chance of developing metabolic encephalopathy:

Acute renal failure (renal disease)
Vitamin B1 deficiency
Hypoglycemia
Hyperosmolar hyperglycemic crisis
Metabolic acidosis
Hyponatremia
Hypernatremia
Hypercalcemia
Sepsis
Hashimoto's thyroiditis
Acute adrenocortical insufficiency
Meningitis
Encephalitis
Hypothermia
Hyperthermia
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
Infections
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:

Symptoms

Symptoms include:

Confusion or agitation
Changes in behavior and personality
Forgetfulness
Disorientation
Insomnia
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.

Diagnosis

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:

Blood tests—usually show high blood ammonia levels and other abnormalities related to the failing liver
Electroencephalogram (EEG)—may be used to determine how the brain has been affected
Imaging studies of the brain ( CT scan or MRI )—may be done to evaluate other causes

Treatment

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

Medications may be used to:

Neutralize toxins
Treat the condition

Dietary Restrictions

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.

Transplantation

If this condition is due to organ failure, you may need a transplant .

Prevention

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.

RESOURCES:

National Digestive Diseases Information Clearinghouse
http://digestive.niddk.nih.gov/index.htm/

National Institute of Neurological Disorders and Stroke
http://www.ninds.nih.gov/

CANADIAN RESOURCES:

Canadian Liver Foundation
http://www.liver.ca/Home.aspx/

Health Canada
http://www.hc-sc.gc.ca/index_e.html/

References:

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 September 2009 by Judy Chang, MD, FAASM

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.