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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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With winters shorter, darker days, melatonin production stretches further into your morning, making you groggy