How to recognize and treat metabolic encephalopathy in Neurology intensive care unit

Berisavac, Ivana; Jovanović, Dejana; Padjen, Višnja; Ercegovac, Marko; Stanarčević, Predrag; Budimkić-Stefanović, Maja S; Radović, M; Beslac-Bumbasirevic, Ljiljana

doi:10.4103/0028-3886.198192

Cited by 12 publications

(6 citation statements)

References 3 publications

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“…Esto coincide con el presente estudio, donde la principal patología que se encontró fue la neumonía nosocomial asociada a la ventilación mecánica, estando presente en el 60% de los pacientes ingresados. 16 . Los pacientes del estudio que presentaron encefalopatías metabólicas y fallecieron presentaron diabetes mellitus descompensada, además de comorbilidades asociadas que también son vinculadas a las encefalopatías, como la hipertensión arterial y la sepsis.…”

Section: Discussionunclassified

Electroencephalographic patterns and clinical evolution in patients with encephalopathy in intensive care unit

Mateu¹,

Aparicio²,

Pena³

et al. 2019

ALERTA

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Introduction. In El Salvador, encephalopathy is one of the clinical conditions with the greatest uncertainty when assessing the prognosis of a patient in the intensive care unit. The electroencephalogram offers a low cost, practical, non-invasive and highly available method through which an evaluation of the neurological status of the patient is achieved. Objective. Study was carried out with the aim of correlating electroencephalographic patterns and clinical evolution of patients with encephalopathy admitted to the medical and surgical intensive care unit during the months of September to December 2018, in National Hospital Rosales. Methodology. An observational, descriptive, longitudinal, prospective. Results. Patients with a diagnosis of encephalopathy were included and chronicled clinical and electroencephalographic variables,age, sex, comorbidities, cause of admission to the intensive care unit, medical or surgical, use of sedative or relaxing drugs, use of vasoactive amines, state of consciousness, complications during intrahospital stay, evolution and outcome: death, transfer or discharge. Conclusion: The most common pattern among patients was epileptiform, showing the highest degree of survival among them, when treated with antiepileptic drugs. The reactivity showed a prognostic value among the patients, 44.44% of 9 non-reactive patients died, and while the 6 reactive patients showed a 100% survival of patients with encephalopathy and EEG pattern with reactivity present during the period of time admitted.

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Section: Discussionunclassified

Electroencephalographic patterns and clinical evolution in patients with encephalopathy in intensive care unit

Mateu¹,

Aparicio²,

Pena³

et al. 2019

ALERTA

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“…Approximately 0.9% of patients using valproate develop hyperammonemic encephalopathy. This number could be higher if patients are taking sedatives and other antiepileptic medications like lamotrigine, topiramate and risperidone [ 13 ]. Carnitine deficiency and urea cycle enzyme abnormalities also expose patients for valproate and topiramate induced hyperammonemic encephalopathy [ [2] , [3] , [4] ].…”

Section: Discussionmentioning

confidence: 99%

“…The cytosolic ammonia accumulated within astrocytes and neuronal cells which is conjugated with glutamine by glutamine synthetase is responsible for the oxidative stress and subsequently leads to mitochondrial swelling and cytosolic edema [ 2 , 14 ]. Availability of electroencephalogram recordings may help improve diagnostic validity, but it is unlikely to facilitate differentiation of VPA from other causes of encephalopathy [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

Hypoxic respiratory failure due to hyperammonemic encephalopathy induced by concurrent use of valproic acid and topiramate, a case report and review of the literature

Raru

Zeid

2018

Respiratory Medicine Case Reports

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Valproic acid (VPA) is widely used for the treatment of epilepsy, migraine, and a variety of psychiatric symptoms, including bipolar disorder, borderline personality disorder, and alcohol withdrawal. Valproate is associated with severe idiosyncratic adverse effects, the most notable being valproate-induced hyperammonemic encephalopathy (VHE). Topiramate is also a broad-spectrum anticonvulsant that is also extensively used for migraine prophylaxis, as a mood stabilizer, and for alcohol dependency. There is increased occurrence of VHE when valproate is used with other medications like phenytoin, phenobarbital, and topiramate. Our case report is on a young patient who was on valproic acid and topiramate and developed metabolic encephalopathy with hypoxic respiratory failure. We reviewed the causes and management of the hyperammonemic encephalopathy. We believe that clinicians should be aware of possible hyperammonemic encephalopathy in any patient who is taking valproic acid and presenting with impaired consciousness and cognitive decline. We also underline the importance of early recognition and high index of suspicion of encephalopathy related to hyperammonemia.

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“…Paradoxically, the brain has limited reserves of oxygen [ 237 ], and therefore requires a continuous supply of oxygenated blood. As a result, irregular oxygen delivery to the brain for even a short period causes brain damage [ 235 ] leading to a loss of consciousness, and chronic oxygen deficiency (regardless of the etiology of the disease) can result in hypoperfusion and irreversible brain damage, thereby provoking encephalopathy with clinical symptoms ranging from minimal changes in intellectual function to dementia and coma, often fatal outcomes [ 59 , 238 , 239 , 240 , 241 , 242 , 243 , 244 ], suggesting some common biochemical background for neurological signs in different diseases.…”

Section: Erythrocyte Metabolic Disturbances As An Indicator Of Mental...mentioning

confidence: 99%

Erythrocytes Functionality in SARS-CoV-2 Infection: Potential Link with Alzheimer’s Disease

Kosenko

Tikhonova

Alilova

et al. 2023

IJMS

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Coronavirus disease 2019 (COVID-19) is a rapidly spreading acute respiratory infection caused by SARS-CoV-2. The pathogenesis of the disease remains unclear. Recently, several hypotheses have emerged to explain the mechanism of interaction between SARS-CoV-2 and erythrocytes, and its negative effect on the oxygen-transport function that depends on erythrocyte metabolism, which is responsible for hemoglobin-oxygen affinity (Hb-O2 affinity). In clinical settings, the modulators of the Hb-O2 affinity are not currently measured to assess tissue oxygenation, thereby providing inadequate evaluation of erythrocyte dysfunction in the integrated oxygen-transport system. To discover more about hypoxemia/hypoxia in COVID-19 patients, this review highlights the need for further investigation of the relationship between biochemical aberrations in erythrocytes and oxygen-transport efficiency. Furthermore, patients with severe COVID-19 experience symptoms similar to Alzheimer’s, suggesting that their brains have been altered in ways that increase the likelihood of Alzheimer’s. Mindful of the partly assessed role of structural, metabolic abnormalities that underlie erythrocyte dysfunction in the pathophysiology of Alzheimer’s disease (AD), we further summarize the available data showing that COVID-19 neurocognitive impairments most probably share similar patterns with known mechanisms of brain dysfunctions in AD. Identification of parameters responsible for erythrocyte function that vary under SARS-CoV-2 may contribute to the search for additional components of progressive and irreversible failure in the integrated oxygen-transport system leading to tissue hypoperfusion. This is particularly relevant for the older generation who experience age-related disorders of erythrocyte metabolism and are prone to AD, and provide an opportunity for new personalized therapies to control this deadly infection.

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How to recognize and treat metabolic encephalopathy in Neurology intensive care unit

Cited by 12 publications

References 3 publications

Electroencephalographic patterns and clinical evolution in patients with encephalopathy in intensive care unit

Electroencephalographic patterns and clinical evolution in patients with encephalopathy in intensive care unit

Hypoxic respiratory failure due to hyperammonemic encephalopathy induced by concurrent use of valproic acid and topiramate, a case report and review of the literature

Erythrocytes Functionality in SARS-CoV-2 Infection: Potential Link with Alzheimer’s Disease

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