Stages of hepatic encephalopathy, infants and children <3 years

Stage	Clinical	Reflexes	Neurologic signs
No encephalopathy (stage 0)	Normal	Normal	None
Early (stage I and II)	Inconsolable crying, sleep reversal, inattention to task, child is not acting like self to parents	Unreliable/ normal or hyperreflexic	Untestable
Mid (stage III)	Somnolence, stupor, combativeness	Unreliable/ hyperreflexic	Likely untestable
Late (stage IV)	Comatose, arouses with painful stimuli (stage IVa) or no response (stage IVb)	Absent	Decerebrate or decorticate

Modified with permission from: Squires RH, Alonso EM. Acute liver failure in children. In: Liver Disease in Children, 4th ed, Suchy FJ, Sokol RJ, Balistreri WF (Eds), Cambridge University Press, New York 2012. Copyright © 2012 Cambridge University Press.

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Stages of hepatic encephalopathy, infants and children <3 years