Following are the predisposing factors for hepatic encephalopathy except: September 2007

Ans. C: Metabolic acidosis Increased ammoniagenesis: - Increased substrate (protein) for ammoniagenesis - Increased protein intake - Gastrointestinal bleeding - Renal failure - Increased catabolism of protein - Hypokalemia - Sepsis Decreased hepatocellular function: - Dehydration - Development of hepatocellular carcinoma - Worsened intrinsic liver disease - Drug toxicity - Superimposed viral hepatitis Increased poocaval shunting: Poal vein thrombosis - Transjugular intrahepatic poosystemic shunt formation Surgical shunt formation - Spontaneous shunt formation Psychoactive drug use: - Benzodiazepines - Ethanol Other mechanisms: - Increased diffusion of ammonia across the blood-brain barrier: Alkalosis may occur, which promotes ammonium ion conversion to less polar and more diffusible ammonia.