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Precipitating factors

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

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.

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