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Metabolic Encephalopathies

Condition: Metabolic encephalopathies (ME) are disorders where medical problems such as blood infections or liver or kidney failure cause brain damage.

Background: Severe illnesses that affect many systems in the body may cause ME. Older age and cognitive impairment may increase the risk. Low blood sugar or not enough vitamin B1 (thiamine) can also cause ME.      

History and Symptoms: Symptoms usually, but not always, come on suddenly. Patients may be confused, uncooperative, and have low energy. With chronic diseases, the symptoms may come on gradually.

Physical Exam: The doctor will check all of the body’s basic functions such as temperature, heart rate, breathing, and blood pressure. He will also check the eyes, and watch and listen to the patient to find out if there are problems with thinking, behavior, and mood, or physical problems like tremors.

Diagnostic Process: Tests of the blood, urine, and spinal fluid are used to show which systems in the body are having problems. High levels of ammonia in the blood suggest ME. Blood tests may also show if there is an infection or if there are drugs or toxins in the blood. CT or MRI may be used to rule out a stroke or other problem.

Rehab Management: The first step is treating the disease that caused ME. Drugs may be given for agitation. If the patient is in the hospital, the medical team will try to keep the patient moving as much as possible so he does not get bed sores or muscle weakness. Other types of treatment may be needed, such as physical therapy and mental health counseling.

Other Resources for Patients and Families: Families can help with both short-term and long-term care to keep ME from coming back and help the patient cope with problems.  

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