TNF and Hepatic failure: The brain concentration of lactate is increased in the acute and chronic liver failure models,296 which correlates with the severity of clinical symptoms, electroencephalogram spectral abnormalities, and degree of microglial activation.297 At the coma phases of encephalopathy in liver failure, brain concentration of lactate reaches 10–12 mM,298 which triggers high concentration of TNF and IL-6 released from microglial cell.