Skip to main content
Log in

Metabolische Ursachen von Bewusstseinsstörungen

Metabolic encephalopathies

  • Leitthema
  • Published:
Intensivmedizin und Notfallmedizin

Zusammenfassung

Eine Vielzahl metabolischer Entgleisungen manifestiert sich mit einer primären Bewusstseinsstörung (metabolische Enzephalopathie). Die Pathomechanismen sind vielfältig. Das klinische Bild ist meist unspezifisch, umfasst sowohl quantitative (Vigilanzminderung) als auch qualitative Veränderungen (Bewusstseinstrübung) und ist variabel im Verlauf. Die klinische Untersuchung fokussiert auf mentale, kognitive Symptome, Hirnnervenfunktion, motorische Defizite und Zeichen der vegetativen Instabilität. Orientierende Laboruntersuchungen sind wegweisend. Eine zerebrale Bildgebung ist bei Unklarheiten großzügig indiziert. Die wichtigsten metabolischen Enzephalopathieformen umfassen Elektrolytstörungen (insbesondere Hyponatriämie), glykämische Entgleisungen, adrenale und thyreoidale Endokrinopathien sowie septische, hepatische, urämische und Wernicke-Enzephalopathie.

Abstract

A wide variety of metabolic disorders may cause global cerebral dysfunction, so-called metabolic encephalopathy. Several pathophysiological mechanisms are involved. Clinical features are usually nonspecific and can range from subtle cognitive difficulties to loss of consciousness and sleep-like coma. Physical examination should focus on mental status, cranial nerve function, motor abnormalities, and features of autonomic instability. Basic laboratory results may point to the underlying cause; however, if inconclusive, cerebral imaging is strongly indicated. The most frequent causes of metabolic encephalopathy are electrolyte abnormalities, hypo- and hyperglycemia, adrenal and thyroidal endocrinopathies, as well as septic, hepatic, uremic, and Wernicke’s encephalopathy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Literatur

  1. Adrogué HJ, Madias NE (2000) Hyponatremia. N Engl J Med 342:1581–1589

    Article  PubMed  Google Scholar 

  2. Arlt W, Allolio B (2003) Adrenal insufficiency. Lancet 361:1881–1893

    Article  CAS  PubMed  Google Scholar 

  3. Bleck TP (2006) Neurological disorders in the intensive care unit. Semin Respir Crit Care Med 27:201–209

    Article  PubMed  Google Scholar 

  4. Brouns R, De Deyn PP (2004) Neurological complications in renal failure: a review. Clin Neurol Neurosurg 107:1–16

    Article  CAS  PubMed  Google Scholar 

  5. Bushinsky DA, Monk RD (1998) Electrolyte quintet: calcium. Lancet 352:306–311

    Article  CAS  PubMed  Google Scholar 

  6. Chalela JA, Kasner SE (2009) Acute toxic-metabolic encephalopathy in adults, UpToDate®, http://www.uptodate.com

  7. Cooper DS (2003) Hyperthyroidism. Lancet 362:459–468

    Article  CAS  PubMed  Google Scholar 

  8. Córdoba J, Mínguez B (2008) Hepatic encephalopathy. Semin Liver Dis 28:70–80

    Article  PubMed  Google Scholar 

  9. Cryer PE (2005) Mechanisms of hypoglycemia-associated autonomic failure and its component syndromes in diabetes. Diabetes 54:3592–3601

    Article  CAS  PubMed  Google Scholar 

  10. DiMauro S, Schon EA (2003) Mitochondrial respiratory-chain diseases. N Engl J Med 348:2656–2668

    Article  CAS  PubMed  Google Scholar 

  11. Häussinger D, Schliess F (2008) Pathogenetic mechanisms of hepatic encephalopathy. Gut 57:1156–1165

    Article  PubMed  Google Scholar 

  12. Hund E (2007) Septische Enzephalopathie. Dtsch Med Wochenschr 132:322–324

    Article  CAS  PubMed  Google Scholar 

  13. Kitabchi AE, Umpierrez GE, Murphy MB, Kreisberg RA (2006) Hyperglycemic crises in adult patients with diabetes: a consensus statement from the American Diabetes Association. Diabetes Care 29:2739–2748

    Article  CAS  PubMed  Google Scholar 

  14. Malouf R, Brust JC (1985) Hypoglycemia: causes, neurological manifestations and outcome. Ann Neurol 17:421–430

    Article  CAS  PubMed  Google Scholar 

  15. Mayo-Smith MF, Beecher LH, Fischer TL et al (2004) Management of alcohol withdrawal delirium. An evidence-based practice guideline. Arch Intern Med 164:1405–1412

    Article  CAS  PubMed  Google Scholar 

  16. McKeon A, Frye MA, Delanty N (2008) The alcohol withdrawal syndrome. J Neurol Neurosurg Psychiatry 79:854–862

    Article  CAS  PubMed  Google Scholar 

  17. Moe SM, Sprague SM (1994) Uremic encephalopathy. Clin Nephrol 42:251–256

    CAS  PubMed  Google Scholar 

  18. Newell-Price J (2006) Cushing’s syndrome. Lancet 367:1605–1617

    Article  CAS  PubMed  Google Scholar 

  19. Pischik E, Kauppinen R (2009) Neurological manifestations of acute intermittent porphyria. Cell Mol Biol (Noisy-le-grand) 55:72–83

    Google Scholar 

  20. Pytel P, Alexander JJ (2009) Pathogenesis of septic encephalopathy. Curr Opin Neurol 22:283–287

    Article  CAS  PubMed  Google Scholar 

  21. Schneider HJ et al (2007) Hypopituitarism. Lancet 369:1461–1470

    Article  CAS  PubMed  Google Scholar 

  22. Sechi G, Serra A (2007) Wernicke’s encephalopathy: new clinical settings and recent advances in diagnosis and management. Lancet Neurol 6:442–455

    Article  CAS  PubMed  Google Scholar 

  23. Vaidya B, Pearce SH (2008) Management of hypothyroidism in adults. BMJ 337:a801

    Article  PubMed  Google Scholar 

  24. Weathers AL, Lewis SL (2009) Rare and unusual … or are they? Less commonly diagnosed encephalopathies associated with systemic disease. Semin Neurol 29:136–153

    Article  PubMed  Google Scholar 

  25. Weisinger JR, Bellorin-Font E (1998) Magnesium and phosphorus. Lancet 352:391–396

    Article  CAS  PubMed  Google Scholar 

  26. Hehrmann R (1996) Die thyreotoxische Krise: Fallstricke in der Diagnostik? Intensivtherapie. Fortschr Med 114:26–31

    Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to F. Sayk.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Sayk, F., Krapalis, A. & Iwen, K. Metabolische Ursachen von Bewusstseinsstörungen. Intensivmed 47, 94–100 (2010). https://doi.org/10.1007/s00390-009-0142-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00390-009-0142-0

Schlüsselwörter

Keywords

Navigation