Besides the accumulation of unmetabolized ammonia other mechanisms have been implied as causes of encephalopathy such as imbalance of neurotransmitters, endogenous benzodiazepine ligands, or elevation of circulating tumor necrosis factor (TNF) [19,20], some of them also involved in the pathogenesis of sepsis-associated delirium [12]. This evidence concerns the gene TNF and Encephalopathy.