Thursday, November 29, 2018

Hypokalemia and hepatic encephalopathy

Q: How diuresis can directly contribute to hepatic encephalopathy in liver cirrhosis patients?

Answer: Diuresis lead to hypokalemia and contraction alkalosis.

1. Hypokalemia increases renal ammonia synthesis

2. Alkalemia increases the conversion of charged ammonium (NH4+) to unionized ammonia (NH3). Unionized ammonia can readily penetrate neurons and can deteriorate hepatic encephalopathy




Gabduzda GJ, Hall PW 3rd. Relation of potassium depletion to renal ammonium metabolism and hepatic coma. Medicine (Baltimore) 1966; 45:481.

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