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:

1. Andy Liu et al. Advances in cirrhosis: Optimizing the management of hepatic encephalopathy. World J Hepatol. 2015; 7(29): 2871–2879
2. 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.