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Objectives

MANAGEMENT AND OUTCOME OF PATIENTS WITH HEPATIC ENCEPHALOPATHY WITH SPECIAL EMPHASIS ON FLUMAZENIL.

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Objectives

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  1. MANAGEMENT AND OUTCOME OF PATIENTS WITH HEPATIC ENCEPHALOPATHY WITH SPECIAL EMPHASIS ON FLUMAZENIL Author:Jaimin Patel (III year resident), K.M. Mehariya (Associate professor) DEPARTMENT OF PAEDIATRICS M. P. SHAH MEDICAL COLLEGE, JAMNAGAR, GUJARAT

  2. Objectives • To know the incidence of hepatic encephalopathy in hospital admission. • To assess the clinical staging • To find out possible etiology. • To observe the role of Flumazenil therapy. • To know the outcome.

  3. Material and Method

  4. Stages

  5. Treatment

  6. Flumazenil One of mech of Hepatic encephalopathy is Increased endogenous Benzodiazepines Mech : Flumazenil competitively antagonizes Benzodiazepines Metabolism: liver, Half life : 1 hr. Duration : 30 to 60 min. Dose : 0.01 mg/kg (max dose :0.2 mg) than 0.005-0.01 mg/kg (max dose : 0.2mg) given every Q 1minute to max total cumulative dose of 1 mg. Doses may be repeated in 20 minutes up to max of 3 mg in 1 hr.

  7. Observation and Results.................

  8. Incidence 1.87/1000

  9. Age: 3.4 years average Sex: M:F :: 1.4:1 Etiology:

  10. Stages

  11. Complications

  12. Investigations Urine Bile salts Bile pigments: 27/29 Serum Bilirubin: 8.6 average PT prolonged in 14/29 SGPT: Raised in all <500 : 4 501-1000 :15 >1000 : 10

  13. Blood transfusion was given in 7 patients Vit K1 in therapeutic doses was given in 14 patients. Plasma required in 4 patients. Flumazenilgiven in 6 Patients * HAV+ve 3 Hbs Ag +ve 3 * among them stage II – 4 pt stage III – 2 pt * one child deteriorated others improved * Response was within 24 hrs max Treatment

  14. Expiry

  15. Conclusion • Incidence : 1.8/1000 in hospital . admission • Etiology: hepatitis B. A and other viral hepatitis - major .. causes • Early intensive care management… • Flumazenil - promising role but needs further evaluation.

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