Table 1

Specific management of encephalopathy

CauseTreatment
InfectionCefotaxime/aciclovir/clarithromycin
Parainfectious/demyelinationSteroids (prednisolone, methylprednisolone)
Immunoglobulins
AutoimmuneSteroids
Immunoglobulins
Plasmapheresis
Immunosuppressants
TraumaNeuroprotective strategies
Neurosurgery
SeizuresAdvanced paediatric life support protocol for status epilepticus
Steroids/clobazam for non-convulsive status
ToxinsOrgan support: for example, intubation, antiarrthymics, management of hypo/hypertension, correction of electrolyte, acid–base and clotting derangement, management of hypo/hyperthermia, treatment of seizures
Activated charcoal (may not be possible if reduced Glasgow Coma Score)
Haemodialysis
Specific antidotes (seek advice from Poisons Information Service)
MetabolicDietary restriction
Clearance of toxic metabolites (dialysis, sodium phenylbutyrate, sodium benzoate, carnitine, glycine)
Specific enzyme/amino acids supplementation for example, thiamine, biotin, arginine, citrulline
Specific drugs (seek advice from metabolic specialist)
HypertensiveAntihypertensives (eg, labetalol, sodium nitroprusside)
Hypoxic-ischaemicAnticoagulation for arterial dissection, venous thrombosis
Aspirin for arterial ischaemic stroke (secondary prevention)
HaemorrhageCorrection of clotting abnormalities
Platelet replacement
Immunoglobulins to be considered in idiopathic thrombocytopenic purpura
Neurosurgery
MalignancySteroids
Neurosurgery
Chemotherapy/radiotherapy