Metabolic Encephalopathy

What is metabolic encephalopathy?

Metabolic encephalopathy is a brain dysfunction caused by an underlying condition. Many possible conditions can cause metabolic encephalopathy, but these mainly target your metabolism. Your metabolism is the chemical process that converts the things you eat and drink into energy. Brain dysfunction can affect your mood, thinking and memory or cause a loss of consciousness (coma).

All metabolic encephalopathies require medical attention. If left untreated, they can be life-threatening or cause permanent brain damage.

What are the types of metabolic encephalopathy?

There are two types of metabolic encephalopathy:

• Acute: Acute metabolic encephalopathy happens due to a lack of vitamins, oxygen or glucose (sugar) within your body.
• Toxic: Toxic metabolic encephalopathy happens due to organ dysfunction or organ failure.

How common is metabolic encephalopathy?

Metabolic encephalopathy is common among people diagnosed as “critically ill” due to the presence of a severe underlying health condition.

What are the signs and symptoms of metabolic encephalopathy?

The first signs of metabolic encephalopathy that you’ll notice affect your cognitive function. These may include:

• Confusion and disorientation.
• Memory loss.
• Personality changes (like irritability or agitation).

Additional signs and symptoms of metabolic encephalopathy include:

• Nausea.
• Fatigue and difficulty sleeping (insomnia).
• Depression.
• Delirium.
• Hallucinations.
• Involuntary movements (tremors).
• Seizures.
• Difficulty breathing.
• Loss of consciousness.

You may notice symptoms appear suddenly but they can progress slowly in some cases. It’s important to contact a healthcare provider if you notice any of these signs or symptoms.

What causes metabolic encephalopathy?

An underlying condition that affects your metabolism causes metabolic encephalopathy. Your metabolism involves a chemical process to convert foods and drinks into energy. Your brain needs energy to function. An underlying condition can cause a chemical imbalance in your blood. As a result, your brain doesn’t get what it needs to function as expected and symptoms of metabolic encephalopathy appear.

Common conditions that cause metabolic encephalopathy include:

• Diabetes (hyperglycemia or hypoglycemia).
• Heart failure.
• Kidney failure.
• Liver disease or liver failure.
• Malnutrition.
• Pancreatitis.
• Sepsis.
• Vasculitis.

Toxic agents can also cause metabolic encephalopathy, including:

• Alcohol.
• Heavy metal poisoning.
• Nonprescribed medications or substances.

What are the risk factors for metabolic encephalopathy?

You may be more at risk of developing metabolic encephalopathy if you:

• Have an underlying condition that affects more than one body system (systemic illness).
• Have more than one medical condition at the same time (comorbidities).
• Are above age 65.
• Actively experience cognitive impairment like memory loss, difficulty learning new things, making decisions or trouble concentrating.
• Experience substance use disorder.

What are the complications of metabolic encephalopathy?

Complications of metabolic encephalopathy can be life-threatening if left untreated and may include:

• Permanent brain damage.
• Coma.

How is metabolic encephalopathy diagnosed?

A healthcare provider will diagnose metabolic encephalopathy after a physical exam, neurological exam and testing. Tests help your healthcare provider rule out possible conditions with similar symptoms and narrow down the affected areas of your body. Tests may include:

• Blood tests.
• Urinalysis.
• Electroencephalography.
• Lumbar puncture.
• A CT scan or an MRI.

How is metabolic encephalopathy treated?

Treatment for metabolic encephalopathy focuses on managing the underlying condition or organ failure that caused your symptoms and the side effects associated with encephalopathy. This varies but may include:

• Taking vitamins or supplements.
• Taking medications.
• Changing what you eat or drink (like limiting fluids).
• Occupational therapy, cognitive behavioral therapy and/or speech therapy.
• Plasmapheresis.
• Undergoing dialysis or receiving an organ transplant.

As you might feel agitated or confused, your care team will treat you in a quiet, stress-free environment in a hospital. If it’s safe, they’ll also schedule times for you to get out of bed and move around under observation to prevent complications from prolonged bed rest.

What medications treat metabolic encephalopathy?

The type of medication your healthcare provider recommends depends on what causes your symptoms. Medications to treat metabolic encephalopathy may include:

• Benzodiazepine and/or opiate antagonists (naloxone).
• Glucocorticoids.
• Thiamine.
• Lactulose.
• Levetiracetam or valproic acid.
• Antiseizure medications.
• Antipsychotic medications.

Are there side effects of the treatment?

Each type of treatment comes with possible side effects that vary. Your care team will monitor you while you’re undergoing treatment to watch for any side effects. If you have questions about your treatment plan, your recovery or how you feel, talk to your healthcare provider.

How soon after treatment will I feel better?

Some people who experience metabolic encephalopathy feel well again within one to two days after treating the cause if they receive a diagnosis quickly. Others may not make a full recovery due to brain damage. They may need lifelong treatment and support.

Can metabolic encephalopathy be prevented?

You can’t prevent all cases of metabolic encephalopathy, but you can take steps to improve your general health to reduce your risk by:

• Eating healthy foods.
• Staying hydrated.
• Getting regular exercise.
• Keeping your brain active by reading, completing puzzles or participating in educational activities.

What’s the outlook for metabolic encephalopathy?

Your outlook depends on how soon you get treatment after your symptoms start and what caused metabolic encephalopathy. You’ll have a better outcome if the condition receives treatment quickly. Many people return to normal mental functioning after treatment. Among other cases, metabolic encephalopathy can cause permanent brain damage, which can be fatal. You may need lifelong support and therapy if the condition damages your brain.

When should I see a healthcare provider?

If you or a loved one experience any symptoms of metabolic encephalopathy, contact a healthcare provider. Some cases may be a medical emergency, and your healthcare provider may recommend you go to the emergency department immediately, especially if you have an underlying condition like diabetes or liver disease.

What questions should I ask my healthcare provider?

• What type of encephalopathy caused my symptoms?
• What type of treatment do you recommend?
• Are there side effects of the treatment?
• Do I need to stay in the hospital for treatment?
• What type of rehabilitation or therapy do you recommend?