Portal systemic encephalopathy (PSE).

Sixtynine cases of portal systemic encephalopathy (PSE) (45 cirrhosis, 24 hepatitis) were seen during 15 months. Coma due to acute viral hepatitis occurred in a younger age group as compared to cirrhosis. Upper gastrointestinal bleeding and hepatic necrosis were the main precipitating factors. Most of the patients were in grade Ill (37.6%) and IV (34.7%) coma when first seen. Blood ammonia nitrogen was raised in all hepatitics and 85% cirrhotics. Serum and urinary electrolytes were deranged in both the groups, while renal function tests were disturbed in more than 50% cases in the two groups. Steroids, diuretics, “Prophylactic” use of broad spectrum antibiotics and intra muscular pitressin might have played an adverse role in the management of coma. The caloric intake prior to and during coma was drastically low in most of the cases. Overall mortality in the series was 74% (JPMA 37:25 ,1987).