Asterix is an involuntary tremor of the wrist caused by muscle relaxation and retraction. It can indicate liver or brain damage caused by liver failure, kidney problems, carbon dioxide toxicity, or Wilson’s disease. Treatment involves addressing the underlying condition.
Asterix is an involuntary tremor of the wrist when it is flexed away from the palm, called dorsiflexion. Normally, muscles are able to stay contracted, but people who have the condition cannot sustain muscle contraction. The wrist muscles involuntarily relax and retract, which causes the wrist to tremble. The tremor occurs in both wrists and is not rhythmic. Asterixis literally means that the hand is not in a fixed position.
This condition is sometimes called a liver flap because it can indicate liver damage or brain damage caused by liver failure. The liver may fail to filter some chemicals from the blood, which in turn can cause brain damage called hepatic encephalopathy. Liver flap can be seen in people who have untreated liver failure, particularly cirrhosis of the liver. Pulse tremor in patients who have this type of liver injury or associated brain damage may be accompanied by the onset of drowsiness or stupor.
Asterixis could also be a sign of too many nitrogenous compounds in the blood, which can be caused by kidney problems. This is called azotemia. The kidneys have difficulty filtering nitrogenous compounds, either because there is some condition preventing the kidneys from getting enough blood to filter or because there is something wrong with the kidneys that prevents them from filtering blood properly despite a normal intake of it. BUN could also be the result of abnormal urine production.
Other conditions associated with asterix include carbon dioxide toxicity and Wilson’s disease. When too much carbon dioxide builds up in the blood, it becomes poisonous to the body. This could cause damage to the brain which could, in turn, cause the tremor.
Wilson’s disease is a buildup of copper in the blood. It can damage the nervous system and liver. Asterix can occur if liver damage causes hepatic encephalopathy.
Treatment of asterix is indirect and consists of treating the damage done to the liver, kidneys or brain and nervous system. Success depends on the reversibility of the underlying damage. Healthcare providers use blood tests to determine the cause of pulse tremors and take steps accordingly.
By lowering the ammonia levels caused by hepatic encephalopathy, the nitrogen compounds caused by blood urea nitrogen and the copper levels caused by Wilson’s disease could stop the trembling of the wrist. It may also be helpful to take certain medications that affect the brain, such as clonazepam. Whatever the cause, the asterixis could be a sign that the underlying condition has become serious and immediate action is needed.
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