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- Grade 1 - Trivial lack of awareness; Euphoria or anxiety; Shortened attention span; Impaired performance of addition. 67% of cirrhotic patients may have 'minimal hepatic encephalopathy'.[5]
- Grade 2 - Lethargy or apathy; Minimal disorientation for time or place; Subtle personality change; Inappropriate behavior; Impaired performance of subtraction
- Grade 3 - Somnolence to semistupor, but responsive to verbal stimuli; Confusion; Gross disorientation
- Grade 4 - Coma (unresponsive to verbal or noxious stimuli) http://www.gastroresource.com/gitextbook/en/chapter14/14-13.htm
Table 289–4. Clinical Stages of Hepatic Encephalopathy
Stage Mental Status Asterixis EEG I Euphoria or depression, mild confusion, slurred speech, disordered sleep +/– Triphasic waves II Lethargy, moderate confusion + Triphasic waves III Marked confusion, incoherent speech, sleeping but arousable + Triphasic waves IV Coma; initially responsive to noxious stimuli, later unresponsive – Delta activity Table 289–3. Common Precipitants of Hepatic Encephalopathy
Increased nitrogen load
Gastrointestinal bleeding
Excess dietary protein
Azotemia
Constipation
Electrolyte and metabolic imbalance
Hypokalemia
Alkalosis
Hypoxia
Hyponatremia
Hypovolemia
Drugs
Narcotics, tranquilizers, sedatives
Diuretics (see "Electrolyte imbalance")
Miscellaneous
Infection
Surgery
Superimposed acute liver disease
Progressive liver disease
Portal-systemic shunts
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