Hepatic Encephalopathy Chart-HELP

[Guest guest]

Ok, I am looking at the chart that is on the links page...and I figured

Noah to be at an 8+.

Somnolence is +4, inappropriate behavior is +3, and metabolic tremor is

+1...now what the heck does +8 mean...there is really no key? Any

ideas anyone? I don't know how bad that is or if he is okay...but we

are okay being at that score. I am really trying to prepare for this

upcoming appointment.

Thanks for any guidance you can provide.

Can you tell I am stressing? I just don't want to, nor can we wait

another 3 months for things to improve for Noah.

[Guest guest]

,

I don't think the sections of the chart

(http://patients.uptodate.com/image.asp?file=hepa_pix/stages5.htm) are

meant to be additive. A grade would be evaluated based on evidence

from the four areas - " State of Consciousness " , " Intellectual

Function " , " Personality-Behavior " and " Neuromuscular abnormalities " .

Looking at the list of abnormalities for " State of Consciousness " -

(Hypersomnia, insomnia or inverted sleep patern, Slow response,

Lethargy, Minimal disorientation, Somnolence, Confusion, Semi-stupor,

Stupor, Unconscious) it looks like a mixture of sleep and conscious

behavior. Noah may just be exhibiting extreme hypersomnia (1+) rather

than somnolence (3+). You have said Noah is having a hard time with

mental tasks - can't do math like he used to, etc. Looking at the

" Intellectual Function " area he has impaired computation and perhaps

shortened attention span but not loss of time or more severe mental

deficits. This again would place him in the (1+) range. " Neuromuscular

abnormalities " are probably the most clinically defined although

muscular incoordination and impaired handwriting can be subjective.

Noah's lack of Asterixix and Slurred speech indicates he is not at

(2+), metabolic tremor would again indicate something in the (1+)

range. Noah's personality-behavior changes have been one of your

primary concerns, and I think that how they are exhibited in a child

may be more extreme than in an adult simply because a child does not

have the inhibitions that adults have developed restricting his

behavior. So what might be called irritability or garrulousness in an

adult may be exhibited as agressive and inappropriate behavior in a

child. Overall, given what you have described, I don't see any reason

to classify Noah's HE above (1+) Mild impairment. This is still a

concern and should not be brushed off, so I think you have a

legitamite gripe with those who have turned a blind eye to Noah's

symptoms.

Good luck with your appointment on Wednesday.

Tim R

>

> Ok, I am looking at the chart that is on the links page...and I

> figured Noah to be at an 8+.

>

> Somnolence is +4, inappropriate behavior is +3, and metabolic tremor

> is +1.