precipitating factors
Last reviewed 01/2018
This condition may be precipitated by:
- 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, alcholic binge, hepatoma
- medications – narcotics, sedatives, paracetamol
- recreational drugs - cocaine, marijuana
- transjugular intrahepatic portosystemic shunt
- high protein diet
- metabolic disturbance for example, hypoglycaemia
Reference:
- (1) Andy Liu et al. Advances in cirrhosis: Optimizing the management of hepatic encephalopathy. World J Hepatol. 2015; 7(29): 2871–2879