Acute Encephalopathy

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“Acute” encephalopathies should ALWAYS be classified as METABOLIC or TOXIC or a combination of both.

  • Acute metabolic encephalopathy
    • Generally due to an internal insult, such as hypernatremia, hypoglycemia, hypoxia, etc.
    • Septic encephalopathy is considered a type of metabolic encephalopathy.
    • The etiology of encephalopathy should be linked when known. Always be sure to clearly document a metabolic encephalopathy in addition to etiology, when applicable.
      • DO document: “acute metabolic encephalopathy due to UTI”
      • DON’T document: “encephalopathy due to UTI” – if criteria to diagnosis as a metabolic encephalopathy is met. Failure to include the term metabolic or toxic codes to “other encephalopathy,” does not adequately capture patient acuity.
  • Acute toxic encephalopathy
    • Generally due to an external insult, such as alcohol, drug, toxin, medication, etc.
    • The etiology should be documented when known.
      • For example, “acute toxic encephalopathy secondary to lithium toxicity”

It is especially important to clearly state when a patient has acute encephalopathy in the setting of a chronic encephalopathy. For example, toxic encephalopathy secondary to medications in the setting of chronic hepatic encephalopathy.

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