Metabolic encephalopathy abnormalities

The metabolic encephalopathies comprise a series of neurological disorders not caused by primary structural abnormalities rather, they result from systemic illness, such as diabetes, liver disease and renal failure. Metabolic encephalopathies usually develop acutely or subacutely and are reversible if the systemic disorder is treated. If left... 

Delirium, toxic confusional state, metabolic encephalopathy or acute confusional state are terms that are used interchangeably and often loosely to describe a syndrome of acutely disordered cognition, sometimes associated with reduced level of consciousness and abnormal attention (see Table 32.1). The syndrome is very common, especially in the elderly and in patients with dementia, and presentations vary widely both in the speed of onset and severity (Siddiqi et al. 2006). The differential diagnosis is broad and includes almost any medical condition, but the commonest causes are sepsis, adverse drug reaction and metabolic derangement (Francis et al. 1990). 

Thiamin deficiency can result in three distinct syndromes a chronic peripheral neuritis, beriberi, which may or may not be associated with heart ilure and edema acute pernicious (fulminating) beriberi (shoshin beriberi), in which heart failure and metabolic abnormalities predominate, without peripheral neuritis and Wernicke s encephalopathy with KorsakofPs psychosis, which is associated especially with alcohol and dmg abuse. The central role of thiamin diphosphate in... 

In one patient with acute valproate-associated encephalopathy associated with biochemical evidence of severe carnitine deficiency and a defect in valproate metabolism, L-carnitine substitution corrected the biochemical abnormalities, but the patient died (SED-13, 150) (1186). 

Murakami K, Sugimoto T, Nishida N, Kobayashi Y, Kuhara T, Matsumoto I. Abnormal metabolism of carnitine and valproate in a case of acute encephalopathy during chronic valproate therapy. Brain Dev 1992 14(3) 178-81. 

Mans AM, De Joseph MR, Hawkins RA. Metabolic abnormalities and grade of encephalopathy in acute hepatic failure. J. Neurochem., 63, 1829-1838, 1994 McEnery MW, Snowman AM, Trifiletti RR, Snyder SH. Isolation of the mitochondrieil benzodiazepine receptor Association with the voltage-dependent anion channel tuid the adenine nucleotide carrier. Proc. Natl. Acad. Sci. USA, 89, 3170-3174, 1992 Mena EE, Cotman CW. Pathologic concentrations of ammonium ions block 1-gluttunate uptake. Exp. Neurol, 59, 259-263, 1985... 

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