Hepatic-encephalopathy may be precipitated by all of the following except :

Answer is C (Hyperkalemia) It is Hypokalemia and not hyperkalemia that precipitates encephalopathy. Hypokalemia may contribute to systemic alkalosis and thereby cause an increase in the amount of non-ionic ammonia (NH), which readily crosses the BBB and accumulates in CNS worsening or precipitating encephalopathy Common precipitants of Hepatic Encephalopathv include : Anaemia may lead to cellular hypoxia at the level of liver cells and thus ppt. encephalopathy Q Barbiturates are CNS depressant drugs and their injudicious use, therefore may precipitate hepatic Q encephalopathy. Hypothyroidism, though not mentioned as a direct precipitating. factor, may contribute towards precipitating encephalopathy by causing 'constipation' or slowing down the intellectual and motor activity. Increased nitrogen load as in GI bleeding Excessive dietary protein intake() Azotemiae Constipation Q Electrolyte and Metabolic imbalance such as in I-Ivpokaleinia Q Hypoxia HyponatremiaQ Drugs Miscellaneous conditions like CNS depressant agents like narcotics, tranquillizers, sedatives () Infection Q,surgeryQ,superimposed acute liver disease. (-)