Encephalopathy: alteration in the level or content of consciousness due to a process extrinsic to the brain.
Metabolic encephalopathy in particular that related to sepsis is the most common cause of ALOC in the ICU setting.
AETIOLOGY:
Hepatic failure
Renal Failure
Respiratory Failure
Sepsis- sepsis associated encephalopathy
Electrolyte abnormalities: hypo and hyper Natraemia, hypercalcaemia
Hypoglycaemia and hyperglycaemia
Acute pancreatitis
Endocrine -addisonian crisis, myxoedema coma, thyroid storm
Drug withdrawal -benzodiazepines, opiates
Hyperthermia
Toxins: alcohols, glycols, TCAs
Intensive care unit syndrome
D lactic acidosis
Distinguishing features of structural and metabolic encephalopathy:
STRUCTURAL:
1. state of consciousness -usually fixed level of depress conscious state, may deteriorate progressively
2. Fundoscopy -maybe abnormal
3. Pupils -may be abnormal in size or response to light
4. Eye movements -may be affected
5. Motor findings -asymmetrical involvement
6. Involuntary movements -not common
METABOLIC
1. State of consciousness -milder alteration of conscious state, waxing and waning of altered sensorium
2. Fundoscopy - usually normal
3. Pupils - usually preserved light response although pupils shape and reactivity affected in certain overdose
4. Eye movements - usually preserved
5. Motor findings -abnormalities usually symmetrical
6. Involuntary movements -asterixis, tremor, myoclonus frequently seen
Metabolic encephalopathy in particular that related to sepsis is the most common cause of ALOC in the ICU setting.
AETIOLOGY:
Hepatic failure
Renal Failure
Respiratory Failure
Sepsis- sepsis associated encephalopathy
Electrolyte abnormalities: hypo and hyper Natraemia, hypercalcaemia
Hypoglycaemia and hyperglycaemia
Acute pancreatitis
Endocrine -addisonian crisis, myxoedema coma, thyroid storm
Drug withdrawal -benzodiazepines, opiates
Hyperthermia
Toxins: alcohols, glycols, TCAs
Intensive care unit syndrome
D lactic acidosis
Distinguishing features of structural and metabolic encephalopathy:
STRUCTURAL:
1. state of consciousness -usually fixed level of depress conscious state, may deteriorate progressively
2. Fundoscopy -maybe abnormal
3. Pupils -may be abnormal in size or response to light
4. Eye movements -may be affected
5. Motor findings -asymmetrical involvement
6. Involuntary movements -not common
METABOLIC
1. State of consciousness -milder alteration of conscious state, waxing and waning of altered sensorium
2. Fundoscopy - usually normal
3. Pupils - usually preserved light response although pupils shape and reactivity affected in certain overdose
4. Eye movements - usually preserved
5. Motor findings -abnormalities usually symmetrical
6. Involuntary movements -asterixis, tremor, myoclonus frequently seen
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