Metabolic Encephalopathy.ppt

Metabolic Encephalopathy

Hendra Zufry

Division of Endocrinology, Endocrinology, Metabolism & Diabetes Dept.of Medicine, School of Medicine, Syiah Kuala University/ Dr. ainoel !bidin "eneral #ospital

DD/ Encepalopathy$

 APPROACH TO THE PATIENT IN COMA 

%omprehensive history & eamination

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'he nec( should be stabili)ed in all instances of trauma until cervical spine fracture or subluation can be ruled out

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in unconscious patients *ith a history of trauma, peritoneal lavage by an eperienced surgeon may be *arranted

Causes of Coma…

More than half of all cases of coma are due to metabolic brain dysfunctions.

Differentiating Toxic-Metabolic Coma from tructural Coma 

+hen the history is available, the patients underlying illnesses and medications, or the setting in *hich they are found, often help guide the physician to the appropriate cause

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'he time course of the illness resulting in coma can be helpful. "enerally, structural lesions have a more abrupt onset, *hereas metabolic or toic causes are more slo*ly progressive

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'he response to initial emergency therapy may help differentiate metabolic or toic causes of coma

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-n general, structural lesions have focal features or at least notable asymmetry on neurological eamination. 'oic, metabolic, and psychiatric diseases are characteri)ed by their symmetry

. Diabetic Ketoacidosis DK!0

2. Hyperosmolar Hyperglicemia State (HHS)   

12 of all diabetes3related admissions More common in elderly & 'ype 4 diabetics Mortality  

5ariable 63762 Most often due to the precipitating illness

%auses of DK!/##S        

8e* diagnosis of Diabetes -nfection9 :neumonia, "astroenteritis, U':ancreatitis !cute M-/!%S Stro(e 'rauma !lcohol/Drugs/Medications Missed -nsulin/%ompliance

Evaluation in DK!/##S 

;aboratory 

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=ther

"lucose Electrolytes

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