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Ammonia levels do not guide management of hepatic encephalopathy

28 May 2020

Neither the presence nor the level of ammonia influences inpatient management of hepatic encephalopathy (HE) with lactulose, which suggests that ammonia levels do not guide therapy in clinical practice, according to a study.

Patients with cirrhosis aged >18 years admitted for management of HE from 2005 to 2015 were included in the analysis. Propensity matching was used to control for confounding by the severity of underlying disease. The authors grouped patients with an ammonia level taken at time of HE diagnosis into two—normal and elevated ammonia levels. Total lactulose (mL) amount (or dose) given in the first 48 hours of HE management was the primary endpoint.

A total of 1,200 admissions with HE were examined, of which 551 (46 percent) patients had their ammonia levels drawn. Of these, 328 (60 percent) showed an abnormal ammonia level (>72 μmol/L). No significant differences were observed in the Child-Pugh score, MELD or Charlson Comorbidity Index between those with and without ammonia levels drawn.

The average total lactulose dose over 48 hours was 167 mL in the no ammonia group and 171 mL in the ammonia group (p=0.41). For patients with an elevated ammonia level, the average lactulose dose was 161 mL, which was identical to the lactulose dose in those with a normal ammonia level.

Furthermore, no association was found between lactulose dose and ammonia level (R2, 0.0026).

“Ammonia appears to play a major role in the pathophysiology of HE, but its role in guiding management is unclear,” the researchers noted.

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Most Read Articles
20 Jun 2020
The Lundbeck Neuroscience Symposium was held at Sofitel KL Damansara over 2 days, with extensivediscussions on the management of various mental illnesses. The second day of the symposiumaddressed the topic of schizophrenia management, focusing on treatment goals, the rationale forpartial dopamine D(2) receptor agonism and the use of long-acting injectable (LAI) antipsychotics topromote adherence.
Stephen Padilla, 15 Jun 2020
Consumption of whole almonds as snacks not only reduces low-density lipoprotein cholesterol (LDL-C) but also significantly improves endothelial function in adults with above-average risk of cardiovascular disease (CVD), according to the results of a trial.
Pearl Toh, 2 days ago
Having migraine during midlife appears to be associated with a higher risk of developing dementia in later life, according to a large population-based longitudinal Danish study presented at the AHS* 2020 Virtual Meeting, indicating that migraine may be a risk factor for dementia.
27 May 2020
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