An often reversible decrease in neurologic function caused by  liver disease.

Can be a Chronic or an Acute finding

Is also seen in portal hypertension and shunting of blood away from the liver.

Ammonia is responsible for toxin – among others

The liver becomes unable to properly decontaminate the blood.  Ammonia is able to crosss the blood brain barrier.  This toxin then causes inflammation to occur in the brain.

Other causes other then liver disease:

   -  Medications:  (Narcotics, Diuretics, Diazepam, Lorazepam)
   -  Alcohol
   -  Infection
   -  Renal Failure
   -  Hypokalemia        *Low potassium in blood
   -  Hyponatremia      *Low sodium in blood
   -  Hypoglycemia     *Low sugar in blood
   -  Dehydration
 

Symptoms include:

   -  Changes in memory and personality
   -  Difficulty to concentrate and slowed reaction time
   -  Tremor  (Asterixis)
   -  Seizures
   -  Agitation
   -  Coma
   -  Swelling in the brain
   -  Changes in speech
   -  Death can occur

Stages:

Subclinical  –  Subtle changes
Stage 1  –  Tremor, incoordination, apraxia
Stage 2  –  Asterisix slowed or slurred speech, Ataxia
Stage 3  –  Hypoactive reflexes, nystagmus, clonus, muscular rigidity
Stage 4  –  Coma, dilated pupils, absence of response to stumuli
 

Treatment:

   -  Decrease protein intake  [This will decrease amount of ammonia]

   -  Correct Hypokalemia, Hyponatremia, and Hypoglycemia

   -  Lactulose – helps decrease ammonia amounts

   -  Rifaximin  [Antibiotics] 

   -  Treat liver disease