Acid-Base in hepatic encephalopathy

Q; 52 years old male with Grade 0 hepatic encephalopathy is intubated due to pneumonia. Is it good or bad to keep PH on the alkalotic side? - choose one

A) Good

B) Bad

Answer: B 

Alkalosis may facilitate the conversion of Ammonium to Ammonia ( NH4 + to NH3). An increase in Ammonia levels will make hepatic encephalopathy worse. There are 4 grades of hepatic encephelopathy but various factors may make it worse or better.

Grade 0 - Minimal hepatic encephalopathy (subclinical). Lack of detectable changes.

Grade 1 - Trivial lack of awareness. Shortened attention span. Impaired addition or subtraction. Hypersomnia, insomnia, or inversion of sleep pattern. Irritability. Mild confusion. Slowing of the ability to perform mental tasks.

Grade 2 - Lethargy. Disorientation. Inappropriate behavior. Slurred speech. Obvious asterixis.

Grade 3 - Somnolent but can be aroused.

Grade 4 - Coma with or without response to painful stimuli

#acid-base

#hepatology

#neurology

References:

1. Kabbani AR, Tergast TL, Manns MP, Maasoumy B. Alkalose, Albumin, Ammoniak und die hepatische Enzephalopathie [Alkalosis, albumin, ammonia and hepatic encephalopathy]. Med Klin Intensivmed Notfmed. 2021 May;116(4):358-359. German. doi: 10.1007/s00063-021-00812-5. PMID: 33825943.

2. James IM, Sampson D, Nashat S, Williams HS, Garassini M. Effect of induced metabolic alkalosis in hepatic encephalopathy. Lancet. 1969 Nov 22;2(7630):1106-8. doi: 10.1016/s0140-6736(69)90706-5. PMID: 4186996.