Critical Matters Acute Metabolic Encephalopathies
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Nov 24, 2022 Dr. Eelco Wijdicks, a neurology professor at the Mayo Clinic, dives deep into acute metabolic encephalopathies. He discusses the pitfalls of overusing the term 'metabolic encephalopathy' and urges a careful diagnostic approach. The conversation covers how severe electrolyte imbalances impact consciousness, alongside the complexities of EEG interpretations. Eelco also highlights the importance of recognizing structural injuries and shares insights on managing prolonged neurologic recovery, emphasizing compassion in critical care after pandemic challenges.
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Labels Can Hide The Real Problem
- "Toxic metabolic encephalopathy" is a catch-all label that often stops deeper diagnostic thinking.
- Dr. Eelco Wijdicks urges clinicians to define what "toxic" or "metabolic" specifically means before using the term.
Suspect Drugs Before Diagnosis
- Consider medication effects first: many delayed recoveries are drug-related.
- Recognize prolonged sedative clearance, especially after long infusions, before pursuing invasive diagnoses.
Examination First, Imaging Next
- Start every evaluation with a detailed neurologic exam and then order targeted tests driven by findings.
- Use MRI when CT is non-diagnostic because MRI often reveals infarcts, anoxic injury, or PRES missed on CT.
