• Asterixis is a tremor of the wrist that occurs when the wrist is extended (dorsiflexed).
• It is also often referred to as a "flapping tremor" or "liver flap."
• Asterixis results from arrhythmic, interrruptions of voluntary muscle contraction resulting in brief lapses in posture.
• It is most often associated with hepatic encephalopathy that results from abnormal metabolism of ammonia to urea, causing brain cell damage.  The subsequent elevated levels of ammonia are due to liver failure.
• In addition to hepatic enephalopathy, asterixis can also be associated with the following conditions:

               -- azotemia

               -- cardon dioxide toxicity

              -- metabolic encephalopathies

              -- Wilson's Disease