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

3. Material and Method Department of pediatrics, G. G. Hospital, Jamnagar. Study place CBC, Urine BS/BP, Fundus, LFTS, USG Abd, Blood Glucose. Investigation 29 Total No of Patients January 2001 to June 2003, 2.5 years. Study period Etiology, Complications and treatment outcome. Looked for Stages I to IV Patients divided into Prospective descriptive Type of study

4. Stages IVa : Marked confusion, coma; responds to painful stimuli IVb :Deep coma; no response to painful stimuli Stuperous; speaks and obeys simple commands Drowsy; inappropriate behavior; flap+ Confused; altered mood or behavior; Psychomotor defects; No flap Stage 4 Stage 3 Stage 2 Stage 1

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

14. Expiry