The main ones include gastrointestinal bleeding, infections (especially spontaneous peritonitis, urinary tract infections and pulmonary infections), disturbances in electrolyte and acid-base balance (e.g. dehydration, hypokalemia, hyponatremia), excessive protein intake, constipation, post-operative transjugular intrahepatic portal vein shunts and the use of sedative drugs such as sleeping pills.