Your SlideShare is downloading. ×
  • Like
  • Save
Hepatic Encephalopathy
Upcoming SlideShare
Loading in...5
×

Thanks for flagging this SlideShare!

Oops! An error has occurred.

×

Now you can save presentations on your phone or tablet

Available for both IPhone and Android

Text the download link to your phone

Standard text messaging rates apply

Hepatic Encephalopathy

  • 2,205 views
Published

 

Published in Health & Medicine
  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Be the first to comment
No Downloads

Views

Total Views
2,205
On SlideShare
0
From Embeds
0
Number of Embeds
0

Actions

Shares
Downloads
0
Comments
0
Likes
2

Embeds 0

No embeds

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
    No notes for slide

Transcript

  • 1. 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
  • 2. 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.
  • 3. 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
  • 4. 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
  • 5. 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
  • 6. 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.
  • 7. Observation and Results.................
  • 8. Incidence 1.87/1000
  • 9. Age: 3.4 years average Sex: M:F :: 1.4:1 Etiology:
  • 10. Stages
  • 11. Complications
  • 12. 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
  • 13. 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
  • 14. Expiry
  • 15. 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.