Management of hepatic encephalopathy in pediatric intensive care

Hepatic encephalopathy (HE) may be defined as a disturbance in central nervous system function because of hepatic insufficiency. This broad definition reflects the existence of a spectrum of neuropsychiatric manifestations related to a range of pathophysiological mechanisms. Present in both acute and chronic liver failure, these neuropsychiatric manifestations are potentially reversible. A full understanding of the pathophysiologic mechanisms causing hepatic encephalopathy is lacking but is under extensive research. In its simplest form, most think of the cause of encephalopathy as the accumulation of toxic substances that are, under normal circumstances, metabolized by the liver. These substances bypass the liver due to the porto-systemic shunting and decreased hepatic clearance. These ”toxins” then lead to neurochemical changes in the central nervous system resulting in disturbance of its function leading to hepatic encephalopathy. Themanagement of a patient with hepatic encephalopathy is usually directed to the management of the underlying liver disease in addition to some specific hepatic encephalopathy-directed treatments. The first step in the management of patients with hepatic encephalopathy should be supportive care .