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ICD-10 R27.8
ICD-9 781.3
DiseasesDB 33950
MeSH C10.597.350

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Synonyms and keywords: Flapping tremor


Asterixis (Greek a, not + stērixis, fixed position) is a flapping tremor of the wrist upon extension (dorsiflexion), sometimes said to resemble a bird flapping its wings. Also called liver flap, it can be a sign of hepatic encephalopathy (damage to brain cells due to the inability of the liver to metabolize ammonia to urea). The exact cause is not known, but it is thought to be related to abnormal ammonia metabolism.

Adams and Foley first described asterixis in 1949 in patients with severe liver failure and encephalopathy.[1] In general, there are brief, arrhythmic interruptions of sustained voluntary muscle contraction causing brief lapses of posture, with a frequency of 3-5 Hz. It is bilateral, but may be asymmetrical. Asterixis is seen most often in drowsy or stuporous patients with metabolic encephalopathies, especially in decompensated cirrhosis or acute hepatic failure. It is also seen in some patients with renal failure and azotemia, and in carbon dioxide toxicity. Asterixis can also be a feature of Wilson's disease.


Life Threatening Causes

Common Causes

Causes by Organ System

Cardiovascular No underlying causes
Chemical/Poisoning No underlying causes
Dental No underlying causes
Dermatologic No underlying causes
Drug Side Effect Ceftazidime
Ear Nose Throat No underlying causes
Endocrine No underlying causes
Environmental No underlying causes
Gastroenterologic No underlying causes
Genetic No underlying causes
Hematologic No underlying causes
Iatrogenic No underlying causes
Infectious Disease No underlying causes
Musculoskeletal/Orthopedic No underlying causes
Neurologic No underlying causes
Nutritional/Metabolic No underlying causes
Obstetric/Gynecologic No underlying causes
Oncologic No underlying causes
Ophthalmologic No underlying causes
Overdose/Toxicity No underlying causes
Psychiatric No underlying causes
Pulmonary No underlying causes
Renal/Electrolyte No underlying causes
Rheumatology/Immunology/Allergy No underlying causes
Sexual No underlying causes
Trauma No underlying causes
Urologic No underlying causes
Miscellaneous No underlying causes

Causes in Alphabetical Order


  1. Adams RD, Foley JM. The neurological changes in the more common types of severe liver disease. Trans American Neurology Association 1949; 74: 217-219.

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