hepatic encephalopathy in acute liver failure
See Decompensated cirrhosis for the patient with established liver disease.
| Acute liver failure The sick liver patient | |
|---|---|
| Etiology | |
| Epidemiology | |
| Clinical presentation | Asterixis, dysarthria, Delirium Progressing to clonus, rigidity Ddx: any other cause for ↓ LOC... surgical sieve time. |
| Pathogenesis | - ↑ ammonia → - ↑ glutamate in astrocytes → cerebral oedema - transport proteins in BBB transport different proteins in exchange for glutamate = ↓ neurotransmitter synthesis - ↓ cerebral glucose metabolism; inhibits Kreb's cycle |
| Diagnostic investigations | ABG: glucose, lactate Ammonia Exclude non-liver causes |
| Management | - Lactulose - aim >4 bowel movements per day (!!). especially useful when there is hyponatraemia - Rifaximin - suppress bacterial overgrowth - RRT can clear ammonia Manage Hyponatraemia; Spontaneous bacterial peritonitis |