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Alkalemia and Hepatic Encephalopathy in a Chronic Dialysis Patient
Parikshit Duriseti1, Rishi Mamtani1, Nicolaos E Madias2
1Department of Medicine, St. Elizabeth's Medical Center, Boston, MA, United States; Department of Medicine, Tufts University School of Medicine, Boston, MA, United States.
Abstract:
Hepatic encephalopathy (HE) includes cognitive, psychiatric and neuromotor abnormalities observed from brain dysfunction secondary to liver disease and/or porto-systemic shunting. HE can have a wide range of clinical manifestations ranging from trivial lack of awareness, decreased attention span, personality changes to confusion, seizures, coma, and death. The onset of HE in cirrhosis is a poor prognostic factor. While HE has a complex pathogenesis which is not completely understood, hyperammonemia plays an important role in neurotoxicity and brain dysfunction. Alkalemia facilitates the conversion of NH4+ to NH3, which is free to cross the blood-brain barrier exacerbating HE. Prompt recognition and correction of underlying risk factors is central to the management of HE.
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