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
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
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
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.................
Age: 3.4 years average Sex: M:F :: 1.4:1 Etiology:
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
Blood transfusion was given in 7 patients
Vit K1 in therapeutic doses was given in 14 patients.