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

#hepatology
#electrolytes


References:

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