Introduction: Hepatic encephalopathy is defined as a spectrum of neuropsychiatric abnormalities in patients with liver dysfunction after exclusion of brain disease. To compare arterial vs venous ammonia levels in hepatic encephalopathy and to correlate the severity of hepatic encephalopathy with arterial as well as venous ammonia levels.
Materials and methods: This study was an observational study conducted on 60 patients of hepatic encephalopathy admitted to a tertiary care hospital and medical institute. For ammonia estimation, arterial and venous samples were collected on first, third, and fifth days of admission. The samples were then centrifuged immediately and analyzed with in 30 minutes of centrifugation on fully automated analyzer by Siemens RxL Dimensions. Patients were thoroughly examined to know the grade of hepatic encephalopathy. Then, arterial and venous ammonia levels were correlated with the severity of hepatic encephalopathy.
Results: Arterial ammonia level measurement is considered better while assessing hepatic encephalopathy when compared with venous ammonia levels. Results of this study also indicated that arterial total ammonia level measurement is a better indicator in assessing the grade of hepatic encephalopathy when compared with venous total ammonia levels. Of all patients, most were in grade I, and the highest level of ammonia was seen in grades III and IV.
Conclusion: Arterial ammonia levels correlated better with the presence and severity of hepatic encephalopathy when compared with venous ammonia levels.
Butterworth RF. Neurosteroids in hepatic encephalopathy: Novel insights and new therapeutic opportunities. J Steroid Biochem Mol Biol 2016;160:94–97. DOI: 10.1016/j.jsbmb.2015.11.006.
Luo M, Guo JY, Cao WK. Inflammation: a novel target of current therapies for hepatic encephalopathy in liver cirrhosis. World J Gastroenterol 2015;21(41):11815–11824. DOI: 10.3748/wjg.v21.i41.11815.
Patidar KR, Bajaj JS. Covert and overt hepatic encephalopathy: diagnosis and management. Clin Gastroenterol Hepatol 2015;13(12):2048–2061. DOI: 10.1016/j.cgh.2015.06.039.
Shawcross DL, Dunk AA, Jalan R. How to diagnose and manage hepatic encephalopathy: a consensus statement on roles and responsibilities beyond the liver specialist. Eur J Gastroenterol Hepatol 2016;28(2):146–152. DOI: 10.1097/MEG.0000000000000529.
Riggio O, Efrati C, Catalano C. High prevalence of spontaneous portal-systemic shunts in persistent hepatic encephalopathy: a case-control study. Hepatology 2005;42(5):1158–1165. DOI: 10.1002/hep.20905.
Anthony PP. The morphology of cirrhosis. Recommendations on definition, nomenclature, and classification by a working group sponsored by the world health organization. J Clin Pathol 1978;31(5):395–414. DOI: 10.1136/jcp.31.5.395.
Bhatia V, Singh R, Acharya SK. Predictive value of arterial ammonia for complications and outcome in acute liver failure. Gut 2006;55(1):98–104. DOI: 10.1136/gut.2004.061754.
Clemmesen JO, Larsen FS, Kondrup J, et al. Cerebral herniation in patients with acute liver failure is correlated with arterial ammonia concentration. Hepatology 1999;29(3):648–653. DOI: 10.1002/hep.510290309.
Ferenci P, Lockwood A, Mullen K. Hepatic encephalopathy–definition, nomenclature, diagnosis, and quantification: final report of the working party at the 11th world congresses of gastroenterology, Vienna, 1998. Hepatology 2002;35(3):716–721. DOI: 10.1053/jhep.2002.31250.
Butterworth RF. Alterations of neurotransmitter-related gene expression in human and experimental portal-systemic encephalopathy. Metab Brain Dis 1998;13(4):337–349. DOI: 10.1023/a:1020641009971.
Butterworth RF. Complications of cirrhosis III. Hepatic encephalopathy. J Hepatol 2000;32(1 Suppl):171–180. DOI: 10.1016/s0168-8278(00)80424-9.
Lockwood AH, Yap EW, Wong WH. Cerebral ammonia metabolism in patients with severe liver disease and minimal hepatic encephalopathy. J Cereb Blood Flow Metab 1991;11(2):337–341. DOI: 10.1038/jcbfm.1991.67.
Stahl J. Studies of the blood ammonia in liver disease. Its diagnostic, prognostic, and therapeutic significance. Ann Intern Med 1963;58(1):1–24. DOI: 10.7326/0003-4819-58-1-1.
Nicolao F, Efrati C, Masini A, et al. Role of determination of partial pressure of ammonia in cirrhotic patients with and without hepatic encephalopathy. J Hepatol 2003;38(4):441–446. DOI: 10.1016/S0168-8278(02)00436-1.
Manjunath R, Nagesh HN, Bhardwaj V. Clinical co relation between arterial versus venous ammonia levels in hepatic encephlopathy in cirrhosis of liver. J Evol Med Dent Sci 2014;3(19):5322–5333. DOI: 10.14260/jemds/2014/2594.
Ong JP, Aggarwal A, Krieger D, et al. Correlation between ammonia levels and the severity of hepatic encephalopathy. Am J Med 2003;114(3):188–193. DOI: 10.1016/s0002-9343(02)01477-8.
Kumar. T. Incidence of cirrhosis caused by hepatitis B virus in different sex and age group in Bihar. JMGMIS 2006;11:52–54.
Chakrabarti P. Helicobacter pylori, gastric juice and arterial ammonia levels in patients with cirrhosis. J Clin Gastroenterol 2002;34(5):578–581. DOI: 10.1097/00004836-200205000-00020.
Nandakumar R, Naik AS, Pandit B, et al. Effect of Helicobacter pylori eradication on serum ammonia levels in patients with chronic liver disease. Indian J Gastroenterol 2003;22:221–223.
Francoz C, Prié D, Abdelrazek W, et al. Inaccuracies of creatinine and creatinine-based equations in candidates for liver transplantation with low creatinine: impact on the model for end-stage liver disease score. Liver Transpl 2010;16(10):1169–1177. DOI: 10.1002/lt.22128.