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Evidence points to both central and peripheral proinflammatory mechanisms working alone or together with neurotoxic molecules, such as NH3.59,60 In turn, hyponatremia, sepsis, gastrointestinal bleeding, and kidney failure precipitate the exogenous production of TNF, which exacerbates HE presentation

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Worked Example: Same Drinks, Different Hydration Levels Real-world example: Picture a 160 lb man who has 4 standard drinks over 2 hours

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