#asterixis

Neurologist: Good, finally.

Asterixis can occur as a neuromuscular manifestation of advanced kidney disease. According to Hammer and McPhee (2019), asterixis is defined as “involuntary hand flapping when the arms are extended and wrists held back to “stop traffic.”” This condition results from altered nerve conduction in metabolic encephalopathy, which can result from many conditions apart from advanced kidney disease. 

Asterixis helps identify metabolic encephalopathy in patients whose mental functions are impaired. The sign is performed by asking the patient to extend both arms with hands dorsiflexed and fingers spread. When asked to maintain this position, asterixis presents as a sudden, brief, nonrhythmic relaxation of muscle tone at the wrist and interphalangeal joints, followed shortly by recovery. This results in a fine tremor. Also known as a flapping tremor, the asterixis can present in uraemia, hypercapnia, and liver disease.