From the Guidelines
Acute metabolic encephalopathy requires prompt identification and treatment of the underlying cause to prevent long-term brain damage and improve patient outcomes. The condition is characterized by altered mental status, including reduced consciousness or altered cognition, personality, or behavior, and can be caused by various factors such as systemic infection, metabolic derangement, inherited metabolic encephalopathies, toxins, hypoxia, trauma, vasculitis, or central nervous system infection 1. Initial management involves stabilizing the patient with airway protection, oxygen support if needed, and IV fluids.
Key Considerations
- Correcting electrolyte abnormalities, such as sodium, calcium, and glucose, is crucial in managing acute metabolic encephalopathy 1.
- Treating infections with appropriate antibiotics, addressing organ dysfunction, removing toxins through dialysis if applicable, and stopping offending medications are also essential 1.
- Supportive care includes maintaining proper nutrition, preventing complications like pressure ulcers, and avoiding physical restraints when possible.
- Medications like haloperidol 0.5-1mg IV/PO or quetiapine 25-50mg PO may be used short-term for severe agitation, but should be used cautiously as they can worsen confusion.
Hyperammonaemia Considerations
- Hyperammonaemia is a critical condition that can lead to brain damage and death if left untreated 1.
- Early symptoms of hyperammonaemia include lethargy, loss of appetite, and vomiting, which can progress to hyperventilation, hypotonia, ataxia, disorientation, seizures, and coma if untreated 1.
- Management of hyperammonaemia is challenging in pediatric populations, and prompt identification and treatment are crucial to improve survival rates 1.
Recommendations
- Prompt identification and treatment of the underlying cause of acute metabolic encephalopathy are critical to prevent long-term brain damage and improve patient outcomes.
- A comprehensive approach to management, including stabilization, specific treatments, and supportive care, is essential to improve patient outcomes.
- Healthcare providers should be aware of the potential for hyperammonaemia and take prompt action to diagnose and treat the condition to prevent brain damage and death 1.
From the Research
Definition and Causes of Acute Metabolic Encephalopathy
- Acute metabolic encephalopathy is a syndrome of temporary or permanent disturbance of brain functions that occurs in different diseases and varies in clinical presentation 2.
- It can be caused by various factors, including hepatic failure, renal failure, sepsis, electrolyte disarray, and Wernicke encephalopathy 3.
- Other causes include hypoxia, ischemia, systemic diseases, and toxic agents 2.
- Metabolic encephalopathies can also be induced by medications or illicit drugs 4.
Clinical Presentation and Diagnosis
- Clinical presentation can range from mild mental disorders to deep coma and death 2.
- Altered brain functioning, going from mild neuropsychological impairment to coma, movement disorders, and the absence of any obvious differential diagnosis are highly suggestive of the diagnosis 5.
- Biological samplings and brain MRI are essential to rule out differential diagnosis, while electroencephalogram may provide important clues in favor of the diagnosis 5.
Treatment and Prognosis
- Treatment consists mainly of correcting the cause, with specific treatment options available for certain conditions, such as hepatic encephalopathy and some drug-induced encephalopathies 5.
- Mortality rates vary depending on the underlying cause, with septic encephalopathy having a mortality rate of 16-65%, and one-year survival of patients with encephalopathy and liver cirrhosis being less than 50% 2.
- Early recognition and treatment of encephalopathy are critical to improving outcomes in critically ill patients 3.