However, patients with TIPS are at increased risk of developing hepatic encephalopathy (HE).[3,4] Up to 23% of post-TIPS patients develop HE.[4] HE is thought to be primarily caused by a rise in ammonia levels after TIPS placement.[3] This occurs due to decreased breakdown of ammonia as a result of bypassing liver parenchyma as well as increased intestinal ammonia production from upregulation of glutaminase.[3] Clinically, HE carries a wide spectrum of presentations, ranging from covert HE to overt HE. Here, GLS is linked to hereditary elliptocytosis.