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[,] Owing to acute liver failure, chronic hepatitis, or cirrhosis, the clearance of ammonia by the liver is diminished, they may reach to the brain, the elevated levels of ammonia and an inflammatory response work in synergy to cause astrocytes to swell and fluid to accumulate in the brain (cerebral edema), thus, affect cerebral function [,] [Figure 7]

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The results of longitudinal studies the results are variable: some have observed a decrease in the relapse phase, followed by an increase 31 Obradovic et al