Most specific sign of metabolic encephalopathy is:
Correct Answer: Asterixis
Description: Ans. a. Asterixis ('Ref: Harrison 19/e p1782, 2066. 1774. 18/e p199. 2259)The presence of asterixis on the motor examination is nonspecific but usually indicates a metabolic or toxic etiology of the delirium. In a drowsy and confused patient, bilateral asterixis is a certain sign of metabolic encephalopathy or drug intoxication."Hepatic encephalopathy is suggested by asterixis and can occur in chronic liver failure or acute fulminant hepatic failure. "-- Harrison 19/e p1782"In patients presenting with encephalopathy, asterixis is often present. Asterixis can be elicited by having patients extend their arms and bend their wrists back. In this maneuver, patients who are encephalopathic have a "liver flap"--i.e., a sudden forward movement of the wrist "-- Harrison 19/e p2066"In a drowsy and confused patient, bilateral asterixis is a certain sign of metabolic encephalopathy or drug intoxication." - Harrison 19/e p1774AsterixisAsterixis (flapping tremor) is a tremor of the hand when wrist is extended (resemble a bird Rapping it's wingsQ) Characterized by inability to actively maintain a position, demonstrated by jerking movements of outstretched hands when bent upward at wristQ.Tremor is caused by abnormal function of the diencephalic motor centers in brain, which regulate the muscles nvolved in maintaining position.Asterixis is associated with various encephalopathies especially due to faulty metabolismQ.It can be seen in any metabolic encephalopathy, e.g. chronic renal failure, severe congestive heart failure, acute respiratory failure and of course commonly decompensated liver failureQ.It can be a sign of hepatic encephalopathy, damage to brain cells presumably due to the inability of the liver to metabolize ammonia to urea (predominantly related to abnormal ammonia metabolism).Asterixis is seen most often in drowsy or stuporous patients with metabolic encephalopathies, especially in decompensated cirrhosis or acute liver failureQ.Asterixis can be prominent after receiving IV phenytoin & also if the patient is on narcotics.Description:Brief, arrhythmic interruptions of sustained voluntary muscle contraction causing brief lapses of postureFrequency: 3-5 HzQIt is bilateral, but may be asymmetricQ.Asterixis is seen in* Chronic renal failureQ* Severe congestive heart failureQ* Acute respiratory failureQ* Hepatic encephalopathyQ (decompensated liver disease)* Wilson's diseaseQ
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