Clinical audit on management of hepatic encephalopathy in children admitted to Gastroenterology and Hepatology Unit of Assiut University Children Hospital

Introduction
Hepatic encephalopathy (HE) is an important metabolic disturbance in children. It is defined as a spectrum of neuropsychiatric abnormalities in patients with liver dysfunction, after exclusion of brain disease.
Patients and methods
A clinical audit on management of HE was applied according to the guideline protocol used in Gastroenterology and Hepatology Unit of Assiut University Children Hospital. The study included 52 children with HE who were admitted to Gastroenterology and Hepatology Unit over 1-year period from the 1 of March 2016 to the 28 of February 2017.
Results
Detailed history intake was recorded in most cases, except history of drug intake, which was not recorded in 23.15% of cases; history of reversal of sleep rhythm, which was not recorded in 17.3% of cases; and history of behavioral changes, which was not recorded in 9.6% of cases. Data of examination were recorded in most cases, except for fetor hepaticus, which was recorded in 42.3% of cases; asterixis, which was recorded in 36.5% of cases; and neurological examination, which was recorded in 91.2% of cases. Basic and mandatory investigations in the diagnosis of HE were done. The standard treatment of HE has been applied except admission to the ICU and prophylactic endotracheal intubation were not applied. Moreover, oral branched-chain amino acids and rifaximin were not given.
Conclusion
The international guidelines for the management of HE have been followed by the Gastroenterology and Hepatology Unit of Assiut University Children Hospital in most treatment lines and that some of the default is owing to poor-resource setting and lack of medication.