Encephalopathy medical therapy: Difference between revisions
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==Medical therapy== | ==Medical therapy== | ||
* General management of patients is important. Stabilizing the patient and treating the specific | * General management of patients is important. Stabilizing the patient and treating the specific cause is the basis of management. | ||
* Airway , breathing and circulation are to be maintained well as the patient may deteriorate any time owing to brain dysfunction. | * Airway , breathing and circulation are to be maintained well as the patient may deteriorate any time owing to brain dysfunction. | ||
* All drugs which have potential of effecting brain function have to be discontinued. | * All drugs which have potential of effecting brain function have to be discontinued. | ||
* [[Haloperidol]] has to be given to prevent [[seizures]] as a | * [[Haloperidol]] has to be given to prevent [[seizures]] as a prophylactic. But it has to be avoided in cases of [[alcohol withdrawal]]. | ||
* In cases of | * In cases of alcoholic encephalopathy, [[thiamine]] should be administered as soon as possible. | ||
===[[Hepatic encephalopathy]]=== | |||
Patients with hepatic encephalopathy are treated taking into account three things. | |||
* General condition | |||
** Care of airways as they may go into respiratory distress any moment. | |||
** Prophylactic intubation | |||
** Treating the precipitants | |||
* Increased clearance of ammonia | |||
** Use of L-ornithine L-aspartate (LOLA) which uses [[ammonia]] in the body to form glutamine from glutamate | |||
** L-carnitine improves the blood ammonia levels | |||
** [[Sodium benzoate]] interacts with [[glycine]] in the body and leads to excretion of ammonia | |||
** [[Sodium phenylacetate]] also results in excretion of ammonia from the body | |||
** Zinc deficiency causes decreased functioning of [[urea cycle enzymes]]. With administration of zinc levels of ammonia decrease. | |||
* Decreased production of ammonia | |||
** [[Lactulose]] administration leads to inhibition of intestinal bacteria which produce ammonia | |||
** [[Neomycin]] is used to decrease the colonic bacterial load and decrease the ammonia levels | |||
** [[Rifaximin]] is a non absorbable antibiotic which destroys colonic bacteria | |||
===[[Hypoxic encephalopathy]]=== | |||
* Commonly seen in neonates as [[perinatal asphyxia]] | |||
* Proper [[ventilation]] has to be maintained | |||
* Maintenance of [[perfusion]] | |||
* Prevention of [[seizures]] | |||
* [[Hypothermia]] can be useful as it decreases brain's metabolic need. | |||
===[[Hypertensive encephalopathy]]=== | |||
* Aim is to reduce the [[diastolic blood pressure]] to a range of 100-105 mm of Hg in 2- 6 hrs. | |||
* Massive reduction of blood pressure is also not advisable as it may cause ischemic attacks. | |||
* Initially infusions are used to control blood pressure and then switched to oral therapy | |||
* Infusion drugs used are [[niardipine]], [[nitroprusside]] and [[labetolol]] | |||
* Oral drugs used are [[nifedipine]], [[captopril]] | |||
==References== | ==References== | ||
Latest revision as of 04:51, 23 July 2012
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Encephalopathy |
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Diagnosis |
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Treatment |
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Encephalopathy medical therapy On the Web |
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American Roentgen Ray Society Images of Encephalopathy medical therapy |
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Risk calculators and risk factors for Encephalopathy medical therapy |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aditya Govindavarjhulla, M.B.B.S. [2]
Overview
Treatment is symptomatic and varies, according to the type and severity of the encephalopathy. Anticonvulsants may be prescribed to reduce or halt any seizures. Changes to diet and nutritional supplements may help some patients. In severe cases, dialysis or organ replacement surgery may be needed.
Medical therapy
- General management of patients is important. Stabilizing the patient and treating the specific cause is the basis of management.
- Airway , breathing and circulation are to be maintained well as the patient may deteriorate any time owing to brain dysfunction.
- All drugs which have potential of effecting brain function have to be discontinued.
- Haloperidol has to be given to prevent seizures as a prophylactic. But it has to be avoided in cases of alcohol withdrawal.
- In cases of alcoholic encephalopathy, thiamine should be administered as soon as possible.
Hepatic encephalopathy
Patients with hepatic encephalopathy are treated taking into account three things.
- General condition
- Care of airways as they may go into respiratory distress any moment.
- Prophylactic intubation
- Treating the precipitants
- Increased clearance of ammonia
- Use of L-ornithine L-aspartate (LOLA) which uses ammonia in the body to form glutamine from glutamate
- L-carnitine improves the blood ammonia levels
- Sodium benzoate interacts with glycine in the body and leads to excretion of ammonia
- Sodium phenylacetate also results in excretion of ammonia from the body
- Zinc deficiency causes decreased functioning of urea cycle enzymes. With administration of zinc levels of ammonia decrease.
- Decreased production of ammonia
Hypoxic encephalopathy
- Commonly seen in neonates as perinatal asphyxia
- Proper ventilation has to be maintained
- Maintenance of perfusion
- Prevention of seizures
- Hypothermia can be useful as it decreases brain's metabolic need.
Hypertensive encephalopathy
- Aim is to reduce the diastolic blood pressure to a range of 100-105 mm of Hg in 2- 6 hrs.
- Massive reduction of blood pressure is also not advisable as it may cause ischemic attacks.
- Initially infusions are used to control blood pressure and then switched to oral therapy
- Infusion drugs used are niardipine, nitroprusside and labetolol
- Oral drugs used are nifedipine, captopril