Diagnosis of exclusion
Due to accumulation of nitrogenous waste products normally metabolized by the liver
Increased metabolism of ammonia to glutamine in CNS
Spectrum of illness ranges from chronic fatigue to acute lethargy
Increased ammonia production, absorption or entry into brain:
GI Bleed
Excess dietary intake of protein
Infection (e.g. SBP)
Hypokalemia
Metabolic Alkalosis
Constipation
Dehydration
Vomiting
Diuretics
Drugs
Opioids
Benzodiazepines (including withdrawal)
ETOH (including withdrawal)
GI Bleed
Excess dietary intake of protein
Infection (e.g. SBP)
Hypokalemia
Metabolic Alkalosis
Constipation
Vomiting
Diuretics
Opioids
Benzodiazepines (including withdrawal)
ETOH (including withdrawal)
Hepatic encephalopathy
Subdural Hematoma
Ethanol toxicity
Hypoglycemia
Methanol toxicity
Wernicke-Korsakoff Syndrome
Acute hepatitis
Hyper/hyponatremia