Definition

This condition is temporary or permanent damage to the brain. The most common cause is an illness or condition that affects the liver. Toxins build up in the bloodstream because the liver is not working normally.

Normal Oxygen Flow to Brain

An interruption of this flow can lead to metabolic encephalopathy.

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Causes

Metabolic encephalopathy is caused by:

• Poisoning
• Diseases (eg, cirrhosis]]> , ]]>hepatitis]]> , ]]>diabetes]]> , ]]>heart disease]]> , ]]>renal failure]]> )
• Medical conditions that cause blood circulation to bypass the liver

Risk Factors

These factors increase your chance of developing metabolic encephalopathy:

• Acute renal failure]]> (renal disease)
• ]]>Vitamin B1]]> deficiency
• ]]>Hypoglycemia]]>
• ]]>Hyperosmolar hyperglycemic crisis]]>
• Metabolic acidosis
• Hyponatremia
• Hypernatremia
• Hypercalcemia
• ]]>Sepsis]]>
• ]]>Hashimoto's thyroiditis]]>
• ]]>Acute adrenocortical insufficiency]]>
• ]]>Meningitis]]>
• ]]>Encephalitis]]>
• ]]>Hypothermia]]>
• Hyperthermia
• Previous history of brain injury (eg, ]]>tumor]]> , ]]>stroke]]> )

Tell your doctor if you have any of these risk factors.

If you have liver problems, the risk of metabolic encephalopathy is increased by:

• Low oxygen levels in the blood
• Infections
• Major surgery
• Any serious illness that causes changes in the body’s chemical make-up or metabolism
• Use of certain medicines, such as sedatives and ]]>narcotics]]>
• Bleeding within the intestines
• Persistent vomiting or ]]>diarrhea]]> that lowers blood potassium levels

The following toxic overdoses can also increase your risk of the condition:

• ]]>Alcohol intoxication]]>
• Sedative-hypnotic overdose
• ]]>Lead poisoning]]>
• ]]>Carbon monoxide poisoning]]>

Symptoms

Symptoms include:

• Confusion or agitation
• Changes in behavior and personality
• Forgetfulness
• Disorientation
• Insomnia]]>
• Muscle stiffness or rigidity
• ]]>Tremor]]> (particularly a flapping tremor of the hands)
• Difficulty speaking
• Asterixis (rapid momentary loss of tone in the muscles)
• Uncontrollable movements or ]]>seizures]]> (rare)
• Stupor or ]]>coma]]>

These problems can develop quickly. They may resolve when the condition is reversed. However, prompt treatment is needed before a coma occurs.

Diagnosis

This condition is very serious. It can quickly become an emergency. You will need to be hospitalized. Doctors will do an exam to assess your neurological condition.

The following tests may be done:

• Blood tests—usually show high blood ammonia levels and other abnormalities related to the failing liver
• Electroencephalogram]]> (EEG)—may be used to determine how the brain has been affected
• Imaging studies of the brain ( ]]>CT scan]]> or ]]>MRI]]> )—may be done to evaluate other causes

Treatment

Prevention

To help reduce your chance of getting this condition, take the following steps:

• Get early treatment for liver problems. If you have liver problems and any of the above symptoms, call your doctor right away.
• If you have a disease (such as cirrhosis), see your doctor regularly.
• Avoid overdosing. Avoid being exposed to poisons or toxins.