Encephalopathy and

Thiamin has a very low toxicity (oral LD5o of thiaminchloride hydrochloride in mice 3-15 g/kg body weight). The vitamin is used therapeutically to cure polyneuropathy, beri-beii (clinically manifest thiamin deficiency), and Wernicke-Korsakoff Syndrome ( Wernicke encephalopathy and Korsakoff psychosis). In mild polyneuropathy, 10-20 mg/d water-soluble or 5-10 mg/d lipid-soluble thiamin are given orally. In more severe cases, 20-50 mg/d water-soluble or 10-20 mg/d lipid-soluble thiamin are administered orally. Patients suffering from beri-beri or from early stages of Wernicke-Korsakoff Syndrome receive 50-100 mg of thiamin two times a day for several days subcutaneously or intravenously until symptoms are alleviated. Afterwards, the vitamin is administered orally for several weeks. 

Target serum theophylline concentrations are 5 to 15 mg/L (28 to 83 fimol/L). Adverse effects generally are not problematic at serum concentrations below 15 mg/L (83 ftmol/L), but the increased risk of adverse effects outweighs the increase in bronchodilation in most patients above 15 mg/L (83 fimol/L).36 Headache, nausea, vomiting, and irritability may occur at serum concentrations less than 20 mg/L (110 fimol/L) but are rare when the dose is started low and increased slowly. More serious adverse effects, including cardiac arrhythmias, seizures, toxic encephalopathy, and death can occur at higher concentrations.18 Arrhythmias and seizures may occur without nausea and vomiting, particularly in chronic toxicity. 

Cirrhosis is the progressive replacement of normal hepatic cells by fibrous scar tissue. This scarring is accompanied by the loss of viable hepatocytes, which are the functional cells of the liver. Progressive cirrhosis is irreversible and leads to portal hypertension that is in turn responsible for many of the complications of advanced liver disease. These consequences include (but are not limited to) spontaneous bacterial peritonitis (SBP), hepatic encephalopathy, and variceal bleeding.1... 

Drug therapy for portal hypertension and cirrhosis can alleviate symptoms and prevent complications but it cannot reverse cirrhosis. Drug therapy is available to treat the complications of ascites, varices, spontaneous bacterial peritonitis, hepatic encephalopathy, and coagulation abnormalities. 

Reye s syndrome A sudden, sometimes fatal, syndrome characterized by encephalopathy and liver degeneration it occurs in children after viral infection and may be associated with aspirin use. 

Western blot A method to detect protein in a given sample of tissue homogenate or extract. It uses gel electrophoresis to separate denatured proteins by mass. Some diagnostic applications for the Western blot include Lyme disease, bovine spongiform encephalopathy, and human immunodeficiency virus (HIV) (it is considered the gold standard for HIV diagnostic testing). 

Full Fanconi syndrome has been reported to be present in some children with lead encephalopathy (Chisolm 1968 Chisolm et al. 1955). According to the National Academy of Sciences (NAS 1972), the Fanconi syndrome is estimated to occur in approximately one out of three children with encephalopathy and PbB levels of approximately 150 pg/dL. Aminoaciduria occurs at PbB levels >80 pg/dL in children with acute symptomatic lead poisoning (Chisolm 1962). The aminoaciduria and symptoms of lead toxicity disappeared after treatment with chelating agents (Chisolm 1962). 

A. M. Herneth, A. Puspok, R. Steindl, and G. Yurdaydin in Advances in Hepatic Encephalopathy and Metabolic Nitrogen Exchange , L. Capocaccia, M. Merli, and O. Riggo, Eds. GRG Press, Boca Raton, 1995, p. 254. 

Schafer DF, Jones EA Hepatic encephalopathy and the gamma-aminobutyric-acid neurotransmitter system. Lancet 1982 ii 18—20. 

Davies, D. C. blood-brain barrier breakdown in septic encephalopathy and brain tumours. J. Anat. 200 639-46, 2002. 

The brain has an absolute dependence on the blood for its immediate supply of oxygen and energy substrates. Interruption of oxygen or substrate supply by compromise of pulmonary or cardiovascular function or metabolic factors results in encephalopathy and, if prolonged, neuronal cell death. The brain uses approximately 20% of the total oxygen supply of the body. While glucose remains the primary energy substrate for the brain, alternative substrates maybe used under certain circumstances (see Ch. 31). 

The urea cycle is essential for the detoxification of ammonia. The urea cycle (Fig. 40-5) converts ammonia to urea (10-20g/day in the healthy adult). A urea cycle enzymopathy, whether associated with cirrhosis or an inherited metabolic defect, often causes a hyperammone-mic encephalopathy and irreversible brain injury (see also Ch. 34). 

Other animal prion diseases. Outbreaks of transmissible mink encephalopathy and chronic wasting disease in captive populations of mink, mule deer and elk in certain regions of the U.S.A. have also been attributed to prion-infected foodstuffs, although the origin of prion infection is unclear [8], Epidemiological studies suggest lateral transmission as the most plausible explanation for the spread of chronic wasting disease in captive populations... 

Bruce, M. etal. Transmission of bovine spongiform encephalopathy and scrapie to mice Strain variation and the species barrier. Philos. Trans. R. Soc. Bond. [Biol] 343 405-411, 1994. 

Hunter, B. and G. Wobeser. 1980. Encephalopathy and peripheral neuropathy in lead-poisoned mallard ducks. 

An elevation of prothrombin time was the single most reliable manifestation of cirrhosis. The combination of thrombocytopenia, encephalopathy, and ascites had the highest predictive value. 

Infectious Dementias. One hundred years ago, the most common cause of dementia was an infection syphilis. Today, syphilis is well treated and seldom left to linger long enough to infect the brain and cause dementia, but a blood test for syphilis remains a routine part of the assessment for patients newly diagnosed with dementia. Today, the most common infectious cause of dementia is HIV/AIDS. Other, rare forms of infection-caused dementia include Creutzfeld-Jakob disease (spongiform encephalopathy) and subacute sclerosing panencephalitis (SSPE), the latter caused by the measles virus in unvaccinated children. 

EFSA was legally established by a European Parliament and Council Regulation adopted in 2002 following a series of food scares in the 1990s including the Bovine Spongiform Encephalopathy and dioxins scandals, which undermined consumer confidence in the safety of the food chain (EFSA 2007). 

Cases of toxic encephalopathy and macro-qAic anemia have been reported from industrial exposures that may have been as low as 60 ppm. Symptoms were headache, drowsiness, lethargy, and weakness. Manifestations of central nervous system instability included ataxia, dysarthria, tremor, and somnolence. These effects were usually reversible. In acute exposures, the central nervous system effects were the more pronounced, whereas prolonged exposure to lower concentrations primarily produced evidence of depression of erythrocyte formation. When exposure was reduced to 20 ppm, no further cases occurred. 

Inhalation exposure of rats and mice (10-25ppm over 2 weeks or 5-50ppm over 13 weeks) caused methemoglobinemia, encephalopathy, and lesions in the liver (hepatocyte necrosis and hepatomegaly), kidney (hyalin nephrosis), and spleen (extramedullary... 

Preeclampsia/eclampsia/nephritis (magnesium sulfate) - Prevention and control of convulsions of severe preeclampsia and eclampsia and for control of hypertension, encephalopathy, and convulsions associated with acute nephritis in children. 

Albumin (human) Epoetin alfa contains albumin, a derivative of human blood. Based on effective donor screening and product manufacturing processes, it carries an extremely remote risk for transmission of viral diseases. No cases of transmission of viral diseases or Creutzfeldt-Jakob disease have ever been identified for albumin. Anemia Not intended for CRF patients who require correction of severe anemia epoetin alfa may obviate the need for maintenance transfusions but is not a substitute for emergency transfusion. Not indicated for treatment of anemia in HIV-infected patients or cancer patients due to other factors such as iron or folate deficiencies, hemolysis, or Gl bleeding, which should be managed appropriately. Hypertension Up to 80% of patients with CRF have a history of hypertension. Do not treat patients with uncontrolled hypertension monitor blood pressure adequately before initiation of therapy. Hypertensive encephalopathy and seizures have occurred in patients with CRF treated with epoetin. 

Hepatic cirrhosis and ascites In these patients, sudden alterations of electrolyte balance may precipitate hepatic encephalopathy and coma. Do not institute therapy until the basic condition is improved. 

In patients who develop unexplained lethargy, vomiting, or changes in mental status, consider hyperammonemic encephalopathy and measure an ammonia level. 

Acute nephritis in chiidren To control hypertension, encephalopathy, and convulsions associated with acute nephritis in children. 

This has been highlighted by a number of food safety issues. For example, lack of confidence that uncertainties were being adequately dealt with has been an important factor in recent public concerns about bovine spongiform encephalopathy and genetically modified crops, especially in Europe. Uncertainty was also a factor in the earlier controversy over alar in apples (e.g., Ames and Gold 1989 Groth 1989 Thayer 1989). 

Carnitine deficiency leads to impaired carnitine shuttle activity the resulting decreased LCFA metabolism and accumulation of LCFAs In tissues and wasting of acyl-carnitine in urine can produce cardiomyopathy, skeletal muscle myopathy, encephalopathy, and impaired liver function. 

Fatty liver, encephalopathy, and sudden unexpected death in early childhood due to medium-chain acyl-coenzyme A dehydrogenase deficiency. 

Hari P, Jain Y, Kabra SK. Eatal encephalopathy and renal failure caused by diethylene glycaol poisoning. J Trop Pediatr 2006 52(6) 442-4. 

Only a small amount of aluminum is absorbed, and is usually readily eliminated in the urine, unless renal function is impaired. Then absorbed Ap+ can contribute to osteoporosis, encephalopathy, and proximal myopathy. There is some concern that excess of aluminium may contribute to the development of Alzheimer s disease and other neurodegen-erative disorders. 

Diazoxide is administered intravenously for the treatment of hypertensive emergencies, particularly malignant hypertension, hypertensive encephalopathy, and eclampsia. It is effective in 75 to 85% of the patients to whom it is administered and rarely reduces blood pressure below the normotensive range. 

A variety of pathological problems involving the CNS have been described in chronic alcoholics, the main ones being Wernicke s encephalopathy and Korsakoff s psychosis Brain damage from chronic ethanol consumption can be especially severe in the elderly and may accelerate aging. 

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