Which is why patients with overt HE are advised to avoid red meats which during digestion create a lot of
ammonia. Other sources of serum
ammonia are the kidneys and skeletal muscle. Normally, ammonia is metabolized by the liver. When the liver function is impaired, shunting of blood around the liver, and increased muscle wasting all lead to increased serum ammonia levels in cirrhotic patients.
But ammonia isn't the only toxin involved in HE.