Metal fog can be caused by hepatic encephalopathy, a brain disorder that occurs when toxins build up in the bloodstream due to liver dysfunction. Some forms of this condition are reversible; others are not. In addition to brain fog, symptoms can include personality changes, confusion, disorientation, and, in advanced stages, reduced consciousness.
At first, the person may experience disrupted sleep, sleeping during the day and staying awake at night. As the condition progresses, people may have increasing confusion and lethargy. In advanced stages, the person can fall into a coma, which can be fatal.

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