Ammonia Levels and Hepatic Encephalopathy in Patients with Known Chronic Liver Disease

Ninan, Jacob; Feldman, Leonard

doi:10.12788/jhm.2794

Cited by 48 publications

(34 citation statements)

References 22 publications

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“…This reduction in ammonia was due to the conversion of a-ketoglutarate to glutamate by the enzyme glutamate dehydrogenase and by improved pyruvate oxidation and tricarboxylic acid cycle flux (33,34). The significance of ammonia in the development of HE is unclear (35,36). However, we found that the GCS improved earlier in patients treated with intravenous l-carnitine plus BCAA than with intravenous BCAA alone, providing further evidence for the effectiveness of intravenous l-carnitine supplementation in treating OHE.…”

Section: Discussionmentioning

confidence: 53%

L-Carnitine for the Treatment of Overt Hepatic Encephalopathy in Patients with Advanced Liver Cirrhosis

Tajiri

Futsukaichi

Kobayashi

et al. 2018

Journal of Nutritional Science and Vitaminology

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Hepatic encephalopathy is a major complication in patients with advanced cirrhosis and is associated with poor prognosis. To evaluate the effectiveness of l-carnitine supplementation in patients with overt hepatic encephalopathy (OHE), outcomes were retrospectively analyzed in patients with OHE who were treated with intravenous branchedchain amino acids (BCAA), with or without intravenous l-carnitine. Twenty-six patients were treated with intravenous BCAA in addition to conventional agents such as lactulose and non-absorbable antibiotics (Group A), and 19 patients were treated with these agents plus intravenous l-carnitine (Group L). Changes in blood ammonia concentrations, hepatic coma grade and the Glasgow Coma Scale (GCS) were compared in the two groups. Recurrence-free survival (RFS) was evaluated in the two groups and in patients who were and were not administered oral l-carnitine supplementation. At baseline, GCS scores were significantly lower and deterioration in liver function greater in Group L. After 3 d of intravenous l-carnitine, however, GCS showed a significantly greater improvement in Group L than in Group A. Blood ammonia levels improved stably over time in Group L. Overall survival and RFS were similar in Group L and Group A, but median RFS was significantly longer in patients who did than did not receive oral l-carnitine supplementation (735 versus 497 d, p50.03). Although these findings are preliminary, l-carnitine supplementation may be a therapeutic option for patients with OHE and disturbed consciousness.

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Section: Discussionmentioning

confidence: 53%

L-Carnitine for the Treatment of Overt Hepatic Encephalopathy in Patients with Advanced Liver Cirrhosis

Tajiri

Futsukaichi

Kobayashi

et al. 2018

Journal of Nutritional Science and Vitaminology

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“…Lactulose can decrease blood ammonia levels by 25%–50% by increasing excretion of nitrogenous waste in the stool . Although ammonia levels do not correlate with levels of HE in liver disease, treatment will result in less ammonia needing to filter through the urea cycle in the liver . Since the synthetic disaccharide is unabsorbable in the small intestine, it has an osmotic effect that can cause loose stools.…”

Section: Common Treatments and Therapiesmentioning

confidence: 99%

Micronutrients in Liver Disease: Roles, Risk Factors for Deficiency, and Recommendations for Supplementation

et al. 2019

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Micronutrients are essential components of the diet and are required to maintain fundamental bodily functions. Liver disease has a profound effect on nutrient intake, metabolism of nutrients, and nutrition status, often resulting in some degree of malnutrition, including micronutrient deficiency. Vitamin and mineral deficiencies can impair metabolic processes at the cellular and biochemical level even before clinical and physical alterations are seen. It is essential that micronutrient status is evaluated as part of a comprehensive nutrition assessment for all patients with chronic or advanced liver disease. Early intervention to correct suspected or confirmed deficiencies may minimize symptoms and improve clinical outcomes and quality of life. In this narrative review, different types of liver disease and associated micronutrient abnormalities are outlined, and methods of micronutrient assessment and supplementation are discussed. (Nutr Clin Pract. 2020;35:50-62)

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“…After crossing the gut barrier, LPS can be transported through the portal vein or lymphatic vessels to the liver. In physiological conditions, the liver is able to control the pathogenic stimuli and remove toxic compounds [26]. In pathological conditions however, this detoxification is partially lost and the unremoved LPS fraction enters the systemic circulation [27].…”

Section: Gut-liver-brain Communicationmentioning

confidence: 99%

Advanced Organ-on-a-Chip Devices to Investigate Liver Multi-Organ Communication: Focus on Gut, Microbiota and Brain

et al. 2019

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The liver is a key organ that can communicate with many other districts of the human body. In the last few decades, much interest has focused on the interaction between the liver and the gut microbiota, with their reciprocal influence on biosynthesis pathways and the integrity the intestinal epithelial barrier. Dysbiosis or liver disorders lead to0 epithelial barrier dysfunction, altering membrane permeability to toxins. Clinical and experimental evidence shows that the permeability hence the delivery of neurotoxins such as LPS, ammonia and salsolinol contribute to neurological disorders. These findings suggested multi-organ communication between the gut microbiota, the liver and the brain. With a view to in vitro modeling this liver-based multi-organ communication, we describe the latest advanced liver-on-a-chip devices and discuss the need for new organ-on-a-chip platforms for in vitro modeling the in vivo multi-organ connection pathways in physiological and pathological situations.

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Ammonia Levels and Hepatic Encephalopathy in Patients with Known Chronic Liver Disease

Cited by 48 publications

References 22 publications

L-Carnitine for the Treatment of Overt Hepatic Encephalopathy in Patients with Advanced Liver Cirrhosis

L-Carnitine for the Treatment of Overt Hepatic Encephalopathy in Patients with Advanced Liver Cirrhosis

Micronutrients in Liver Disease: Roles, Risk Factors for Deficiency, and Recommendations for Supplementation

Advanced Organ-on-a-Chip Devices to Investigate Liver Multi-Organ Communication: Focus on Gut, Microbiota and Brain

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