Study of blood ammonia levels in hepatic encephalopathy patients

Abstract

Background: Hepatic encephalopathy is a complex neuropsychiatric syndrome occurring in patients with significant liver disease. It is characterized by personality changes intellectual impairment and a depressed level of consciousness. The ranges from subtle cerebral dysfunction to deep coma. There are few studies available on the blood ammonia levels in patients with hepatic encephalopathy and there are very few studies on blood ammonia levels among Indian patients. Aims and Objective: 1) To study the grades of consciousness and blood ammonia levels in hepatic encephalopathy. 2) To study the blood ammonium levels in hepatic encephalopathy patients during the disease and after recovery. 3) To study the significance of blood ammonia levels as diagnostic and prognostic tool. Design and Methods: A total of 100 patients comprised of 22 patients with grade 1 hepatic encephalopathy 40 patients with grade 2, 32 with grade 3 and 6 patients with grade 4 hepatic encephalopathy were studied. Results: The mean blood ammonia level (µmol/L) ± SD during hepatic encephalopathy was as follows. In grade-1 hepatic encephalopathy 129.56 ± 28.11; in grade-2 161.26± 42.0; in grade-3 194.8±42.1; and in grade-4 264.0±34.7. The mean ± SD of blood ammonia level after recovery was in grade-1 53.4 ± 20.9; in grade-2 46.57 ± 15.40; in grade-3 51.6 ± 9.9. Between grade-1 and grade-2 t=2.79 p<0.01, between grade-2 and grade-3 t=2.12, p<0.05, between grade-3 and grade-4 t=3.05 and p<0.01 and the co-relation between the grades of hepatic encephalopathy and mortality r=0.98,t=6.9 and p<0.001. Conclusion: Raised blood ammonia levels appears to be an important laboratory abnormality seen in patients with hepatic encephalopathy and there is a significant co-relation between severity of hepatic encephalopathy and blood ammonia levels in these patients.

Keywords

• hepatic encephalopathy
• blood ammonia