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Factors precipitating hepatic encephalopathy

Patients with chronic liver disease are prone to hepatic encephalopathy which manifest as altered sensorium. It may be precipitated by a variety of causes which can be prevented.

1. Increased nitrogen load
Increased nitrogen load is seen in the following conditions
Gastrointestinal bleeding, since the blood contain large quantity of proteins when there is GI bleed, there will be protein load in intestine.It is acted upon by intestinal bacteria leading to  increased NH3
Excess dietary protein intake.

2. Electrolytic imbalances
Hypokalemia(secondary to diuretic therapy, paracentesis,vomiting) stimulates renal NH3 production.
Systemic alkalosis.

3. Drugs
Diuretics produce electrolyte imbalance
Narcotics, sedatives

4. Infections
Superimposed acute viral hepatitis
Alcoholic hepatitis
Extrahepatic bileduct obstruction

5. Surgeries