It is a neuropsychiatric syndrome secondary to liver disease characterized by unconsciousness.
- Cirrhosis of liver
- Acute fulminant hepatitis
- Biliary cirrhosis
- Surgical portal venous shunt
- Portal hypertension
- High protein intake
- Fluid electrolyte imbalance
- GI bleeding
Hepatic coma occurs when blood bypass the liver through collateral circulation .as the liver is the main detoxification organ of toxic substance, so toxic substances directly reach the brain. These substances include ammonia, free fatty acids, and false neurotransmitters. These toxic substances are responsible for hepatic encephalopathy.
Initially there is irritability, confusion, disorientation, slow slurred speech.
Nausea, vomiting, weakness, hiccups, drowsiness.
Hyperventilation and pyrexia.
Fetor hepaticus (musty sour smell).
Coarse flapping tremors
Bilateral extensor planter response.
Jaundice may be present.
Blood complete picture will show increased ESR, WBC and decreased RBC.
Liver biochemistry will show prolonged prothrombin time, increased SGOT, SGPT and bilirubin.
Blood urea will show the renal status.
Blood glucose can exclude the hypoglycemia.
Dural and subdural hemorrhage
Primary psychiatric disorders
Hospitalized the patient
Pass nasogastric tube and insert cannula to maintain I.V line
Identify the precipitating factors and remove them
Catheterize the patient.
Liquid protein free diet.
Give purgatives with enemas.
IV 20 % glucose.
Correct any electrolyte imbalance.
Oral neomycin 1-4 g daily?
Correct ay infection.
Increase the protein intake slowly
Avoid precipitating factors
Avoid sedatives and hypnotics
Use flumazanil (benzodiazepine antagonist)