The Internet Book of Critical Care Podcast IBCC Episode 38 - Hepatic Encephalopathy
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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.
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Severe Hepatic Encephalopathy Defined
- Severe hepatic encephalopathy in ICU patients is often chronic and may lead to intubation.
- Acute hepatic failure presents differently and is far more malignant with a worse prognosis.
Identifying Hepatic Encephalopathy
- Use respiratory alkalosis and history of apathy as clues to hepatic encephalopathy when exam is limited.
- Remember asterixis is often unhelpful in intubated or somnolent patients.
Ammonia Lab Testing Limitations
- Checking ammonia levels rarely changes management and should not delay therapy.
- High ammonia supports the diagnosis but normal levels do not exclude hepatic encephalopathy.