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

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

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

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

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

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

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

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

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

10. Lab Tests Cont.
Toxicology Screens
Alcohol level
Neuro Imaging

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

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

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

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

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

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

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