Devabhaktuni Spandana, Patkar Prajakta, Pooja V, Dhamija Sana, Gupta Nishtha, Chaudhury Suprakash, Saldanha Daniel
Department of Psychiatry, Dr. D. Y. Patil Medical College, Dr. D. Y. Patil Vidyapeeth, Pune, Maharashtra, India.
Ind Psychiatry J. 2021 Oct;30(Suppl 1):S214-S220. doi: 10.4103/0972-6748.328865. Epub 2021 Oct 22.
Hepatic encephalopathy (HE) is an important and potentially life threatening complication in alcoholic patients with decompensated liver function that develop even as they continue drinking. Delirium tremens, on the other hand, is an acute condition resulting from alcohol abstinence in a person dependent on alcohol, making it a life threatening diagnosis that requires intensive care and successful management of the withdrawal. Often in medical wards, these two conditions are mistaken and so is the management plan confused with each other. Making the right diagnosis early on during the hospital course is extremely important in these critical conditions so as to make an appropriate schedule for treatment and a better outcome for the same. A case series of patients who presented with a diagnostic dilemma is reported. Clinical examinations, diagnostic tools to measure the levels of ammonia and liver function tests and hemogram, West Haven criteria and Child-Pugh grading, and clinical scales of these patients are reported. Increased levels of ammonia were present in all the cases. The subtle similarities in the presentation of the two conditions often make it confusing for the clinician to distinguish between them. Using a simple test of measuring ammonia levels in the blood helps in such situations. The detection of raised levels of ammonia in cases of chronic liver disease helps in not just the diagnosis but also is an important prognostic indicator for development of HE.
肝性脑病（HE）是肝功能失代偿的酒精性患者的一种重要且可能危及生命的并发症，即使在他们持续饮酒时也会发生。另一方面，震颤谵妄是依赖酒精的人戒酒引发的一种急性病症，这使其成为一种需要重症监护和成功管理戒断症状的危及生命的诊断。在医疗病房中，这两种病症常常被误诊，治疗方案也相互混淆。在这些危急情况下，在住院过程中尽早做出正确诊断对于制定合适的治疗计划并取得更好的治疗效果极为重要。本文报告了一系列存在诊断困境的病例。报告了这些患者的临床检查、测量氨水平和肝功能测试及血常规的诊断工具、韦斯特黑文标准和Child-Pugh分级以及临床量表。所有病例均存在氨水平升高的情况。这两种病症表现上的细微相似之处常常使临床医生难以区分它们。在这种情况下，通过简单的血液氨水平检测有助于诊断。在慢性肝病病例中检测到氨水平升高不仅有助于诊断，也是肝性脑病发生的重要预后指标。
