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Etiological and Laboratory Parameters in Children with Hepatic Encephalopathy: A Tertiary Care Study

Prof. Rajniti Prasad, Professor, Department of Pediatrics, Institute of Medical Sciences, B.H.U, Varanasi221005, Uttar Pradesh, India. , Lalit Malviya* , P.C. Jha** , B.K. Das*** , Rajniti Prasad***

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Pediatric Education and Research 5(2):p 75-80, May-Aug 2017. | DOI: https://dx.doi.org/10.21088/per.2321.1644.5217.15

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Abstract

Introduction: Hepatic encephalopathy is a common neuropsychiatric syndrome seen in patients with significant hepatic dysfunction and liver failure, in the absence of neurological disorders. Common causes of hepatic encephalopathy includes, viral hepatitis, Wilson disease, autoimmune hepatitis and idiopathic. Very few studies have been conducted in India on causes and prognostic factors of hepatic encephalopathy. Methods: The present observational study was done in children aged 1 to 18 years of age, of either sex admitted in pediatric ward as a case of hepatic encephalopathy. Fifty two children, who fulfilled the inclusion criteria were enrolled and subjected to detailed laboratory investigations to find out the etiology. All enrolled children were managed as per standard hospital protocol. Basic parameters, investigations and outcome were recorded in pretested proforma. Children were further divided into two groups: Group Ithose who improved and discharged and Group IIchildren who died to find out prognostic factors in such children. Results: The mean age of the study population was 81.54 ± 42.4 months with a range of 1 18 years. Male to female ratio in study was 2.5:1.Wilson’s disease was found to be the most common cause of hepatic encephalopathy (42.3%) followed by Idiopathic (26.9%), Hepatitis A (21.1%), Hepatitis B (7.6%) and autoimmune hepatitis (5.7%). Out of 52 patients, 35 improved and were discharged and 17 had died. All the patients in group II had INR more than 4 while the corresponding figure was 34 % in the group I. Conclusion: Wilson disease was the most common cause of hepatic encephalopathy and INR and stage of encephalopathy were major determinant of outcome. Children in hyperacute liver failure and acute liver failure had also poor outcome.

Keywords: Hepatic Encephalopathy; Wilson Disease; Hepatitis; INR. 

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DOI: https://dx.doi.org/10.21088/per.2321.1644.5217.15

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