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Encephalopathies in the Surgical ICU

Overview of encephalopathies in surgical ICU patients: etiology, clinical presentation, and the two overarching treatment goals of supportive care and targeted therapy.

Source
Encephalopathies | SurgCritCare
Status
review pending
Updated
5/29/2026
On this page
On this page

Encephalopathies are pathological states that affect brain function. In the surgical intensive care setting, several etiologies must be considered when a change in neurologic function occurs.

  • Severity spectrum:*
  • Mild: confusion, agitation, personality change, memory loss, somnolence
  • Severe: hallucinations, seizures, coma

Causes of Encephalopathy in the Surgical ICU

Etiology • Notes • Drug-related
Section
EtiologyNotes
Drug-relatedRecreational drugs, pre-hospital medications, current treatment medications
MetabolicAcidosis, mineral/electrolyte deficiencies, vitamin deficiencies
Primary brain infectionViral and bacterial (meningitis, encephalitis)
Wernicke encephalopathyβ1 (thiamine) deficiency — commonly seen in alcohol use disorder

Two Overarching Treatment Goals

Adequate oxygenation • Adequate perfusion • Treatment of elevated ICPs if needed
Section

1. Supportive Care

  • Adequate oxygenation
  • Adequate perfusion
  • Treatment of elevated ICPs if needed

2. Targeted Therapy

  • If an underlying cause can be determined, direct therapy to eliminate the cause of brain dysfunction

Why Encephalopathy Recovery Can Be Slow

Since encephalopathy is multifactorial, other causes for neurologic dysfunction can slow recovery even when a presumed primary...
Section

Since encephalopathy is multifactorial, other causes for neurologic dysfunction can slow recovery even when a presumed primary source is being treated.

  • ICU care of severe encephalopathies must include:*
  • Nutrition
  • Maintenance of electrolyte levels
  • Respiratory support and pulmonary hygiene
  • Frequent neurologic monitoring
  • Adapted from SurgCritCare. org for structured display and mobile use. Verify against current institutional policies and attending guidance.*
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