Toxic Metabolic Encephalopathy John W. Melton, M.D.

“Encephalo” Greek word: Enkephalos –Brain “Patho” Pathema - disease

Encephalopathy is “caused by something else” “The patient’s encephalopathy comes from _______________.”

Toxic/Metabolic Implies a remote (outside the CNS) etiology

Hallmark of Toxic Metabolic Encephalopathy (TME) alteration of mental status “Drowsy and Confused”

Symptoms lethargy poor concentration personality changes loss of memory/cognitive function Delirium/Hypervigilance/ progressive loss of consciousness

Symptoms – Cont. myoclonus/motor impersistance loss of ability to speak delusions/hallucinations absence of pain loss of ability to swallow Seizures or tremor

Lab Tests Frequently, diagnosis can be made with help of lab tests CBC liver function tests ammonia blood glucose

Lab Tests – Cont. sodium level BUN/Creatinine ABG’s Blood Cultures

Lab Tests Cont. Toxicology Screens Alcohol level Neuro Imaging

ICD-9 Codes 348.30 Encephalopathy, unspecified 348.31 Metabolic/Septic Encephalopathy 291.2 Alcoholic Encephalopathy 572.2 Hepatic Encephalopathy 437.2 Hypertensive Encephalopathy 349.82 Toxic Encephalopathy

ICD-9 Code: 348.31 Metabolic/Septic Encephalopathy Urinary tract infection pneumonia frequent underlying dementia

ICD -9 Code: 291.2 Alcoholic Encephalopathy acute drunkenness alcohol withdrawal * tremor * seizures * confusion * delirium tremors DT’s * delusions/hallucinations * frequent underlying dementia

ICD –9 Code: 572.2 Hepatic Encephalopathy hx of alcoholism, cirrhosis, or hepatitis abnormal liver enzymes and ammonia level frequent underlying dementia

ICD -9 Code: 437.2 Hypertensive Encephalopathy only recently recognized “posterior reversible encephalopathic syndrome” (PRES)

ICD –9 Code: 349.82 Toxic Encephalopathy acute drunkenness poisons organic chemicals medicines

Toxic Metabolic Encephalopathy Summary look for an alteration in mental status “drowsy and confused” usually look for an etiology outside the CNS