The Internet Book of Critical Care Podcast
IBCC Episode 38 - Hepatic Encephalopathy
May 30, 2019
Explore the complexities of hepatic encephalopathy, including nitrogen reduction, the role of shunts, and diagnostic challenges. Learn about differentiating hepatic encephalopathy from alcohol withdrawal and the use of lactulose in treatment. Discover the importance of avoiding sedating medications and implementing nutritional support. Explore the challenges of maintaining gut access in patients with hepatic encephalopathy and alternative treatment options.
21:26
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Quick takeaways
- Differentiating hepatic encephalopathy from other causes of delirium can be challenging, but clinical features such as asterixis and respiratory alkalosis can provide some clues.
- It is crucial to distinguish between hepatic encephalopathy and alcohol withdrawal, as sedating medications, including benzodiazepines, can worsen hepatic encephalopathy.
Deep dives
Overview of Critical Hepatic Encephalopathy
Critical hepatic encephalopathy is the most severe form of hepatic encephalopathy, affecting individuals in the ICU who are somnolent or intubated. The prognosis for patients with chronic hepatic dysfunction is generally poor, although temporary salvage can be achieved during their ICU course. Differentiating hepatic encephalopathy from other causes of delirium can be challenging, but clinical features such as asterixis and respiratory alkalosis can provide some clues. Laboratory studies, including liver function tests and ammonia levels, are useful primarily for ruling out other problems rather than confirming hepatic encephalopathy. While lactulose is a key treatment, ammonia levels do not dictate management decisions.
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