Toxic encephalopathy
Did you see this article in CDI Strategies this week? I'm confused...I thought that encephalopathy d/t severe infection or uremia would be metabolic. And isn't elevated ammonia d/t liver disease hepatic encephalopathy?
Note from the CDI Education Director: Toxic encephalopathy, navigating internal and external threats to brain function
August 22, 2024
CDI Strategies - Volume 18, Issue 34
by Deanne Wilk, MPS, BSN, RN, CCDS, CCDS-O, CDIP, CCS
Toxic encephalopathy, a neurological disorder causing brain dysfunction, is often misunderstood as solely resulting from external toxins. However, this condition can also arise from the body's own metabolic processes gone awry, presenting a complex challenge for healthcare providers and CDI specialists. Here is an overview of the condition including signs and symptoms, diagnosis and treatment, and relevance for CDI teams.
Understanding toxic encephalopathy
Definition: A form of brain dysfunction caused by exposure to toxic substances, either external or internal.
Prevalence: In liver disease, approximately 50% of patients with cirrhosis develop hepatic encephalopathy, a specific form of toxic encephalopathy.
Pathophysiology: As organ function deteriorates, particularly in the liver or kidneys, the body struggles to filter toxins, allowing them to accumulate in the bloodstream and impact brain function.
Common internal toxins
Ammonia: Elevated levels in liver disease can lead to encephalopathy, with symptoms ranging from confusion to coma.
Uremic toxins: Accumulation in kidney failure can cause cognitive and neurological impairments.
Bilirubin: High levels in liver or biliary disorders can contribute to encephalopathy.
Lactic acid: Elevated due to poor tissue oxygenation can lead to metabolic encephalopathy.
Ketones: Increased in uncontrolled diabetes, potentially leading to brain dysfunction.
Inflammatory mediators: In severe infections or autoimmune disorders, these can exacerbate neurological symptoms.