MANAGEMENT AND OUTCOME OF PATIENTS WITH HEPATIC ENCEPHALOPATHY  WITH  SPECIAL EMPHASIS ON FLUMAZENIL Author : Jaimin Patel...
Objectives <ul><li>To know the incidence of hepatic encephalopathy in hospital admission. </li></ul><ul><li>To assess the ...
Material and Method Department of pediatrics,  G. G. Hospital, Jamnagar. Study place CBC, Urine BS/BP, Fundus, LFTS, USG A...
Stages IVa  : Marked confusion, coma; responds to painful stimuli IVb  :Deep coma; no response to painful stimuli Stuperou...
Treatment <ul><li>IV Fluids, dextrose 10%, electrolytes  </li></ul><ul><li>Lactulose – every 4 hrly 0.3 to 0.4 ml/kg to st...
Flumazenil One of mech of Hepatic encephalopathy is Increased endogenous  Benzodiazepines Mech  : Flumazenil competitively...
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 al...
Treatment <ul><li>Blood transfusion  was given in 7 patients </li></ul><ul><li>Vit K1  in therapeutic doses was given in 1...
Expiry
Conclusion <ul><li>Incidence : 1.8/1000 in hospital  </li></ul><ul><li>.   admission  </li></ul><ul><li>Etiology: hepatiti...
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Hepatic Encephalopathy

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Hepatic Encephalopathy

  1. 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. 2. Objectives <ul><li>To know the incidence of hepatic encephalopathy in hospital admission. </li></ul><ul><li>To assess the clinical staging </li></ul><ul><li>To find out possible etiology. </li></ul><ul><li>To observe the role of Flumazenil therapy. </li></ul><ul><li>To know the outcome. </li></ul>
  3. 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. 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. 5. Treatment <ul><li>IV Fluids, dextrose 10%, electrolytes </li></ul><ul><li>Lactulose – every 4 hrly 0.3 to 0.4 ml/kg to start with and dose </li></ul><ul><li>adjusted between 10-50 ml sufficient to cause frequency of 3 </li></ul><ul><li>times/day. </li></ul><ul><li>3.Antibiotics – Ampicillin 100 mg/kg in 4 divided doses </li></ul><ul><li>4.Flumazenil in 6 patients </li></ul><ul><li>5.Blood transfusions in Severe anemia </li></ul><ul><li>6.Vit K1 therapeutic dose 5mg/kg for 3 days </li></ul><ul><li>prophylactic dose 1mg/kg wkly till Jaundice decreasing. </li></ul><ul><li>7.Plasma was given in patients whose PT doesn't improve after </li></ul><ul><li>therapeutic doses of Vit K1 </li></ul><ul><li>8.Ranitidine 3mg/kg/24 hr </li></ul>
  6. 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. 7. Observation and Results.................
  8. 8. Incidence 1.87/1000
  9. 9. Age: 3.4 years average Sex: M:F :: 1.4:1 Etiology:
  10. 10. Stages
  11. 11. Complications
  12. 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. 13. Treatment <ul><li>Blood transfusion was given in 7 patients </li></ul><ul><li>Vit K1 in therapeutic doses was given in 14 patients. </li></ul><ul><li>Plasma required in 4 patients. </li></ul><ul><li>Flumazenil given in 6 Patients </li></ul><ul><li>* HAV+ve 3 </li></ul><ul><li>Hbs Ag +ve 3 </li></ul><ul><li>* among them stage II – 4 pt </li></ul><ul><li> stage III – 2 pt </li></ul><ul><li>* one child deteriorated </li></ul><ul><li>others improved </li></ul><ul><li>* Response was within 24 hrs </li></ul><ul><li>max </li></ul>
  14. 14. Expiry
  15. 15. Conclusion <ul><li>Incidence : 1.8/1000 in hospital </li></ul><ul><li>. admission </li></ul><ul><li>Etiology: hepatitis B. A and </li></ul><ul><li>other viral hepatitis - major . . causes </li></ul><ul><li>Early intensive care management… </li></ul><ul><li>Flumazenil - promising role </li></ul><ul><li>but needs further evaluation. </li></ul>

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