TABLE 21.  Common precipitants of hepatic encephalopathy

Increased nitrogen load Gastrointestinal bleeding Excess dietary protein Azotemia Constipation

Electrolyte imbalance Hyponatremia Hypokalemia Metabolic alkalosis/acidosis Hypoxia Hypovolemia

Drugs Narcotics, tranquilizers, sedatives

Miscellaneous Infection Surgery Superimposed acute liver disease Progressive liver disease Transjugular intrahepatic portal-systemic shunt (TIPS)