How is encephalopathy managed in patients with acute liver failure (ALF)?

Updated: Jun 13, 2019
  • Author: Gagan K Sood, MD; Chief Editor: BS Anand, MD  more...
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Patients with grade I encephalopathy may sometimes be safely managed in a medicine ward. Frequent mental status checks should be performed, and transfer to an intensive care unit (ICU) is warranted with progression to grade II encephalopathy.

Sedation should be avoided if possible. Unmanageable agitation may be treated with short-acting benzodiazepines in low doses.

Patients should be positioned with the head elevated at 30°. Efforts should be made to avoid patient stimulation. Maneuvers that cause straining or, in particular, Valsalva-like movements may increase intracranial pressure (ICP).

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