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Hepatic encephalopathy is a neuropsychiatric complication of severe liver dysfunction in which toxic substances, particularly ammonia, accumulate in the blood and affect brain function. Metabolic disturbances play an important role in precipitating or worsening hepatic encephalopathy, especially in critically ill patients with chronic liver disease or cirrhosis. Hyperammonemia: The most important metabolic disturbance is increased blood ammonia. Normally, ammonia produced from intestinal protein metabolism is converted into urea by the liver and eliminated through the kidneys. In severe hepatic dysfunction or portosystemic shunting, ammonia is not adequately detoxified. It crosses the blood-brain barrier and is taken up ____ ______ ___ __________ _____ _______.
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