liver and brain, marked by rapid development of life-threatening neurologic symptoms. Is an emergency illness chiefly affecting children and teenagers. It almost always follows a viral illness. Causes: - the precise mechanism of this disorder is unknown. Signs and Symptoms: - Stage I - persistent, heavy vomiting - generalized lethargy - general mental symptoms - nightmares - Stage I - stupor - hyperventilation - fatty liver - Stage I I - continuation of Stages I & I - possible coma - possible cerebral edema -rarely, respiratory arrest - Stage IV - deepening coma - large pupils -minimal but stil present hepatic dysfunction - Stage V - very rspid onset following stage IV - deep coma - seizures - respiratory failure - flaccidity - extremely high blood Diagnostic Tests: - Spinal Tap, can help the doctor identify or rule out other diseases with similar s/s such as infection of the lining that surrounds the brain and spinal cord( meningitis) or inflammation or infection of the brain( encephalitis). - Liver biopsy, can help the doctor identify other conditions that may be affecting the liver. - CT scan and MRI, can help the doctor identify other causes of behavior changes or decreased alertness. - Liver biopsy, can help the doctor identify other conditions that may be affecting the liver. - CT scan and MRI, can help the doctor identify other causes of behavior changes or decreased alertness. Nursing and Medical Managements: - intravenous fluids - insulin - corticosteroids - diuretics Complication: - permanent brain damage