EFFECT OF NORMALIZATION OF PLASMA AMINO-ACIDS ON HEPATIC ENCEPHALOPATHY IN MAN

Abstract

Previous work suggested that the plasma amino acid pattern, known to be deranged in hepatic encephalopathy, may be related causally. In order to test this hypothesis, 23% dextrose and a special amino acid solution whose components were calculated to normalize the plasma amino acid pattern were infused in 11 patients, 8 with chronic cirrhosis and acute exacerbation (Group 1) and 3 patients with fulminant hepatitis (Group 2), in amounts of up to 120 g. of protein equivalent/24 h. Plasma amino acids were abnormal but different in both groups. In Group 1 (cirrhosis) changes in plasma amino acid pattern including elevated phenylalanine, tyrosine, glutamate, aspartate, and methionine and decreased valine, leucine and isoleucine. In Group 2 all amino acids were elevated, with the exception of the branched chains which were normal. Hepatic encephalopathy improved in all patients in Group 1 and in 1 of 3 patients in Group 2 following the infusion. The ratio .**GRAPHIC**. showed an excellent correlation with a grade of encephalopathy. When this ratio, previously 1.0 in the presence of encephalopathy, returned to the normal value near 3.0-3.5, encephalopathy improved. An excellent correlation was obtained between the ratio and the grade of encephalopathy and was dose related as well. Different amino acid patterns in hepatic encephalopathy of differing etiologies require treatment modalities which may differ for the 2 types of encephalopathy. Whereas amino acid infusion appears to be a valuable, efficacious way of providing nutrition in treating hepatic encephalopathy in patients with cirrhosis and acute deterioration and coma, other means of therapy such as plasma laundering appear to be necessary in patients with fulminant hepatitis.