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Amino acid challenge in patients with cirrhosis: A model for the assessment of treatments for hepatic encephalopathy

Lookup NU author(s): Dr Andrew Douglass, Dr Christopher Record

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Abstract

Background/Aims: To mimic episodic hepatic encephalopathy after gastrointestinal bleeding under controlled conditions, cirrhotic patients were challenged with an amino acid mixture of comparable composition to haemoglobin. Methods: Basal EEG, psychometric score (HE test), reaction times and venous blood ammonia were recorded. Following a 54 or 108 gm oral amino acid challenge, blood ammonia levels and EEG were recorded at 30-min intervals, and psychometric testing was repeated at 180 min. Ten controls (57 ± 2) and 31 cirrhotics (52 ± 2) of which 21 were Child's grade A or B and 10 grade C underwent the challenge. Nine had a transjugular intrahepatic porta-systemic shunt in situ. Results: Seventeen patients had abnormal baseline HE scores. Basal blood ammonia and reaction time A were significantly greater in patients (52 ± 5 μmol/l and 478 ± 20 ms, respectively) than controls (19 ± 2 μmol/l and 372 ± 14 ms) (P < 0.001). Following the challenge, in patients with advanced liver disease (Child's grade B and C) the slowing of reaction time A (+85 ± 38 and +71 ± 31 ms, respectively; P < 0.03) and EEG (ratio of slow to fast wave activity +0.31 ± 0.12 and +0.58 ± 0.19; P < 0.02) were significantly greater than in controls (-3.3 ± 8 ms and 0.00 ± 0.03, respectively). Patients with an abnormal basal HE score had the most pronounced changes (reaction time A +110 ± 39 ms, P < 0.01, EEG +0.52 ± 13, P < 0.01, respectively). The change in EEG ratio correlated with the dose of amino acid administered (r = 0.96; P < 0.008). Conclusion: The amino acid challenge constitutes a reproducible human model of episodic, Type C hepatic encephalopathy unaffected by the complications usually encountered in clinical practice. © 2001 European Association for the Study of the Liver. Published by Elsevier Science B.V.

Publication metadata

Author(s): Douglass A; Record C; Al Mardini H

Publication type: Article

Publication status: Published

Journal: Journal of Hepatology

Year: 2001

Volume: 34

Issue: 5

Pages: 658-664

ISSN (print): 0168-8278

ISSN (electronic): 1600-0641

Publisher: Elsevier BV

URL: http://dx.doi.org/10.1016/S0168-8278(01)00004-6

DOI: 10.1016/S0168-8278(01)00004-6

PubMed id: 11434611

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