Toxic-metabolic encephalopathy in adults: Critical discussion and pragmatical diagnostic approach

Abstract

Toxic-metabolic encephalopathy (TME) results from an acute cerebral dysfunction due to different metabolic disturbances including medications or illicit-drugs. It can lead to altered consciousness, going from delirium to coma, which may require intensive care and invasive mechanical ventilation. Even if it is a life-threatening condition, TME might have an excellent prognosis if its etiology is rapidly identified and treated adequately. This review summarizes the main etiologies, their differential diagnosis, and diagnostic strategy and management of TME with a critical discussion on the definition of TME.

Keywords: Blood-brain barrier; Coma; Delirium; Disorders of consciousness; Encephalopathy; ICU; Inborn error of metabolism; Metabolic encephalopathy; Toxic-metabolic encephalopathy.