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Hepatic Encephalopathy
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Hepatic Encephalopathy

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    Hepatic Encephalopathy Hepatic Encephalopathy Presentation Transcript

    • MANAGEMENT AND OUTCOME OF PATIENTS WITH HEPATIC ENCEPHALOPATHY WITH SPECIAL EMPHASIS ON FLUMAZENIL Author : Jaimin Patel (III year resident), K.M. Mehariya (Associate professor) DEPARTMENT OF PAEDIATRICS M. P. SHAH MEDICAL COLLEGE, JAMNAGAR, GUJARAT
    • Objectives
      • To know the incidence of hepatic encephalopathy in hospital admission.
      • To assess the clinical staging
      • To find out possible etiology.
      • To observe the role of Flumazenil therapy.
      • To know the outcome.
    • Material and Method Department of pediatrics, G. G. Hospital, Jamnagar. Study place CBC, Urine BS/BP, Fundus, LFTS, USG Abd, Blood Glucose. Investigation 29 Total No of Patients January 2001 to June 2003, 2.5 years. Study period Etiology, Complications and treatment outcome. Looked for Stages I to IV Patients divided into Prospective descriptive Type of study
    • Stages IVa : Marked confusion, coma; responds to painful stimuli IVb :Deep coma; no response to painful stimuli Stuperous; speaks and obeys simple commands Drowsy; inappropriate behavior; flap+ Confused; altered mood or behavior; Psychomotor defects; No flap Stage 4 Stage 3 Stage 2 Stage 1
    • Treatment
      • IV Fluids, dextrose 10%, electrolytes
      • Lactulose – every 4 hrly 0.3 to 0.4 ml/kg to start with and dose
      • adjusted between 10-50 ml sufficient to cause frequency of 3
      • times/day.
      • 3.Antibiotics – Ampicillin 100 mg/kg in 4 divided doses
      • 4.Flumazenil in 6 patients
      • 5.Blood transfusions in Severe anemia
      • 6.Vit K1 therapeutic dose 5mg/kg for 3 days
      • prophylactic dose 1mg/kg wkly till Jaundice decreasing.
      • 7.Plasma was given in patients whose PT doesn't improve after
      • therapeutic doses of Vit K1
      • 8.Ranitidine 3mg/kg/24 hr
    • Flumazenil One of mech of Hepatic encephalopathy is Increased endogenous Benzodiazepines Mech : Flumazenil competitively antagonizes Benzodiazepines Metabolism : liver, Half life : 1 hr. Duration : 30 to 60 min. Dose : 0.01 mg/kg (max dose :0.2 mg) than 0.005-0.01 mg/kg (max dose : 0.2mg) given every Q 1minute to max total cumulative dose of 1 mg. Doses may be repeated in 20 minutes up to max of 3 mg in 1 hr.
    • Observation and Results.................
    • Incidence 1.87/1000
    • Age: 3.4 years average Sex: M:F :: 1.4:1 Etiology:
    • Stages
    • Complications
    • Investigations Urine Bile salts Bile pigments: 27/29 Serum Bilirubin: 8.6 average PT prolonged in 14/29 SGPT: Raised in all <500 : 4 501-1000 :15 >1000 : 10
    • Treatment
      • Blood transfusion was given in 7 patients
      • Vit K1 in therapeutic doses was given in 14 patients.
      • Plasma required in 4 patients.
      • Flumazenil given in 6 Patients
      • * HAV+ve 3
      • Hbs Ag +ve 3
      • * among them stage II – 4 pt
      • stage III – 2 pt
      • * one child deteriorated
      • others improved
      • * Response was within 24 hrs
      • max
    • Expiry
    • Conclusion
      • Incidence : 1.8/1000 in hospital
      • . admission
      • Etiology: hepatitis B. A and
      • other viral hepatitis - major . . causes
      • Early intensive care management…
      • Flumazenil - promising role
      • but needs further evaluation.