Tuesday March 24, 2009


Q; 52 year old male with Grade 0 hepatic encephalopathy is intubated due to pneumonia. Is is good or bad to keep PH on alkalotic side? - choose one

A) Good

B) Bad



Answer is B - Bad


Alkalosis may facilitate the conversion of Ammonium to Ammonia ( NH4 + to NH3). Increase Ammonia level will make hepatic encephelopathy worse. There are 4 grades of hepatic encephelopathy but various factors may make it worse or better.

Grade 0 - Minimal hepatic encephalopathy (subclinical). Lack of detectable changes.

Grade 1 - Trivial lack of awareness. Shortened attention span. Impaired addition or subtraction. Hypersomnia, insomnia, or inversion of sleep pattern. Irritability. Mild confusion. Slowing of ability to perform mental tasks.

Grade 2 - Lethargy. Disorientation. Inappropriate behavior. Slurred speech. Obvious asterixis.

Grade 3 - Somnolent but can be aroused.

Grade 4 - Coma with or without response to painful stimuli