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. 2009 Aug 3;5:617–626. doi: 10.2147/tcrm.s4443

Table 2.

Common precipitants of hepatic encephalopathy and the underlying mechanisms

  1. Increased nitrogen load
    1. Excess dietary protein
    2. Constipation
    3. Gastrointestinal bleeding
    4. Blood transfusions
    5. Azotemia
    6. Infection
    7. Hypokalemia
  2. Decrease toxins clearance
    1. Dehydration
      1. Fluid restriction
      2. Excessive diuresis
      3. Abdominal paracentesis
      4. Diarrhea due to laxatives
    2. Hypotension
      1. Bleeding
      2. Systemic vasodilatation
    3. Anemia
    4. Porto systemic shunts (iatrogenic and spontaneous)
  3. Altered neurotransmission
    1. Benzodiazepines
    2. Psychoactive drugs
  4. Hepatocellular damage
    1. Continued alcohol abuse
    2. Development of hepatocellular carcinoma