Physiology of the liver:How should we interpret the blood ammonia level? Keita SHIMATA 1 , Motohiko TANAKA 2 , Taizo HIBI 1 1Department of Pediatric Surgery and Transplantation Kumamoto University Graduate School of Medical Sciences 2Department of Gastroenterology and Hepatology Kumamoto University Graduate School of Medical Sciences pp.175-181
Published Date 2020/1/1
DOI https://doi.org/10.11477/mf.3102200723
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Hepatic encephalopathy (HE) is a potentially reversible neuropsychiatric disorder resulting from liver failure. Ammonia plays a central role in the pathogenesis of HE, and aromatic amino acids and their pseudo-neurotransmitter derivatives are also reported as causative substances. In patients with liver cirrhosis, intricate interactions between multiple organs exist and it is difficult to confirm the diagnosis of HE and predict its outcome based solely on blood ammonia level. Therefore, the clinical implications of ammonia level measurement after oral glutamine challenge in this patient cohort remain unknown. However, in patients with acute liver failure, high blood ammonia levels due to acute liver damage resulting in cerebral edema is the main cause. As a consequence, the blood ammonia level is considered to be a prognostic factor. In conclusion, the blood ammonia level should be interpreted judiciously with the clinical situation of each patient taken into account.

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