Precipitating factors
This condition may be precipitated by: (1,2)
- diarrhoea:
- hypokalaemia increases renal ammonia production
- alkalosis increases the amount of ammonia that crosses the blood-brain barrier
- diuretics
- vomiting
- gastrointestinal bleeding - increases the nitrogenous content in the bowel;- in effect a protein rich diet
- infection - chest, urinary tract, spontaneous bacterial peritonitis
- acute liver cell decompensation - for example, alcoholic binges, hepatoma
- medications – narcotics, sedatives, paracetamol
- recreational drugs - cocaine, marijuana
- transjugular intrahepatic portosystemic shunt
- high protein diet
- metabolic disturbance for example, hypoglycaemia
Reference:
- Andy Liu et al. Advances in cirrhosis: Optimizing the management of hepatic encephalopathy. World J Hepatol. 2015; 7(29): 2871–2879
- Vilstrup H, Amodio P, Bajaj J, et al. Hepatic encephalopathy in chronic liver disease: 2014 practice guideline by the American Association for the Study of Liver Diseases and the European Association for the Study of the Liver. Hepatology. 2014 Aug;60(2):715-35.
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