Let’s differentiate between the use of terms ’cause’ and ‘tigger’ or ‘precipitant’ on this site. In the context of Hepatic encephalopathy, the ’causes’ are reasons for liver faiure such as Cirrhosis, toxic tylenol hepatitis, alcohol hepatitis etc. ! But in someone with underlying cirrhosis, they can have hepatic encephalopathy ‘triggered’ by anything that increases ammonia production or reduces ammonia processing or excretion. The mnemonic HEPATIC MIND helps me recall such triggers & target appropriate investigations in the context of my patient:
H – Hemorrhage (GI ) : Blood digestion raises Ammonia, especially Upper GI, recall that BUN levels go up too
E – Electrolyte issues (low potassium, low Sodium, Low Glucose). (Have discussed KCL dosing before)
P – Paracentesis (large volume) : Reduced circulating volume affects renal Urea/Ammonium excretion
A – AKI , retains more ammonium/urea
T – Thrombosis (portal / hepatic vein ) , TIPS procedure. TIPS helps ammonia bypass liver urea cycle
I – Infections (SBP/UTI etc.) Body makes more ammonia in infection inflammation
C – Constipation: More colonic bacterial ammonia production
M – Medications: Sedatives, Narcs, etc
I – Intoxications: Alcohol hepatitis on top on cirrosis
N – Non-compliance w/ meds : esp Lactulose
D – Dehydration: Perhaps the most common precipitor of Hepatic Encephalopathy
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