Effect of blood ammonia elevation following oral glutamine load on the psychometric performance of cirrhotic patients

Metabolic Brain Disease

Volumn 18, Issue 1, 2003, Pages 27-35

  Masini, Andrea ^a   Efrati, Cesare ^a   Merli, Manuela ^a   Nicolao, Francesca ^a   Amodio, Piero ^b   Del Piccolo, Franco ^b   Riggio, Oliviero ^a,c  

^a SAPIENZA UNIVERSITY OF ROME   (Italy)

^b UNIVERSITY OF PADOVA   (Italy)

^c NONE   (Italy)

Author keywords

Ammonia; Cirrhosis; Glutamine challenge; Minimal encephalopathy; Psychometric performance

Indexed keywords

AMMONIA; GLUTAMINE; PLACEBO; TAP WATER;

ADULT; AGED; AMINO ACID ANALYSIS; AMMONIA BLOOD LEVEL; ANALYTIC METHOD; ANALYTICAL PARAMETERS; ARTICLE; BRAIN DISEASE; CLINICAL ARTICLE; CLINICAL TRIAL; CONTROLLED CLINICAL TRIAL; CONTROLLED STUDY; HEPATIC ENCEPHALOPATHY; HUMAN; HYPERAMMONEMIA; LIVER CIRRHOSIS; MALE; PERFORMANCE; PROVOCATION TEST; PSYCHOMETRY; SAFETY; WORKING MEMORY;

ADMINISTRATION, ORAL; ADULT; AGED; AMMONIA; FEMALE; GLUTAMINE; HUMANS; LIVER CIRRHOSIS; MALE; MIDDLE AGED; PSYCHOMETRICS;

EID: 0037369016     PISSN: 08857490     EISSN: None     Source Type: Journal    
DOI: 10.1023/A:1021926601907     Document Type: Article

References (38)

1. Amodio, P., Del Piccolo, E, Marchetti, P., Angeli, P., Iemmolo, R., Caregaro, L., Merkel, C., Gerunda, G., and Gatta, A. (1999). Clinical features and survival of cirrhotic patients with subclinical cognitive alterations detected by the number connection test and computerized psychometric tests. Hepatology 29:1662-1667.
2. Amodio, P., Del Piccolo, F., Petteno, E., Mapelli, D., Angeli, P., Iemmolo, R., Muraca, M., Musto, C., Gerunda, G., Rizzo, C., Merkel, C., and Gatta, A. (2001). Prevalence and prognostic value of quantified electroencephalogram (EEG) alterations in cirrhotic patients. J. Hepatol. 35:37-45.
3. Amodio, P., Marchetti, P., Del Piccolo, F., Campo, G., Rizzo, C., Iemmolo, R.M., Gerunda, G., Caregaro, L., Merkel, C., and Gatta, A. (1998a). Visual attention in cirrhotic patients: A study on covert visual attention orienting. Hepatology 27:1517-1523.
4. Amodio, P., Marchetti, P., Del Piccolo, F., Rizzo, C., Iemmolo, R.M., Caregaro, L., Gerunda, G., and Gatta, A. (1998b). Study on the Sternberg paradigm in cirrhotic patients without overt hepatic encephalopathy. Metab. Brain Dis. 13:159-172.
5. Amodio, P., Wenin, H., Del Piccolo, F., Mapelli, D., Montagnese, S., Pellegrini, A., Musto, C., Gatta, A., and Umiltà, C. (2002). Variability of Trailmaking Tests, Symbol Digit Test and Line Trait Test in normal people. A normative study taking into account age-dependent decline and sociobiological variables. Aging Clin. Exp. Res. 14:117-131.
6. Blei, A.T., Olafsson, S., Therrien, G., and Butterworth, R.F. (1994). Ammonia-induced brain edema and intracranial hypertension in rats after portacaval anastomosis. Hepatology 19:1437-1444.
7. Butterworth, R.E (2000). Complications of cirrhosis III. Hepatic encephalopathy. J. Hepatol. 32:171-180.
8. Conn, H.O. (1977). Trailmaking and number-connection tests in the assessment of mental state in portal systemic encephalopathy. Am. J. Dig. Dis. 22:541-550.
9. Douglass, A., Al Mardini, H., and Record, C. (2001). Amino acid challenge in patients with cirrhosis: A model for the assessment of treatments for hepatic encephalopathy. J. Hepatol. 34:658-664.
10. Efrati, C., Masini, A., Merli, M., Valeriano, V., and Riggio, O. (2000). Effect of sodium benzoate on blood ammonia response to oral glutamine challenge in cirrhotic patients: A note of caution. Am. J. Gastroenterol. 95:3574-3578.
11. Fujiwara, M., Watanabe, A., Hashimoto, M., Yamauchi, Y., Nakatsukasa, H., Kobayashi, M., Higashi, T., and Nagashima, H. (1986). Prevention of ammonia-induced brain edema in dogs infused with a branched-chain amino acid solution. Biochem. Med. Metab. Biol. 36:207-209.
12. Gerok, W., and Haussinger, D. (1984). Ammonia detoxification and glutamine metabolism in severe liver disease and its role in the pathogenesis of hepatic coma. In (D. Haussinger and H. Sies, eds.), Glutamine Metabolism in Mammalian Tissues, Springer, Heidelburg, Germany, pp. 257-277.
13. Kircheis, G., Nilius, R., Held, C., Berndt, H., Buchner, M., Gortelmeyer, R., Hendricks, R., Kruger, B., Kuklinski, B., Meister, H., Otto, H.J., Rink, C., Rosch, W., and Stauch, S. (1997). Therapeutic efficacy of L-ornithine-L-aspartate infusions in patients with cirrhosis and hepatic encephalopathy: Results of a placebo-controlled, double-blind study. Hepatology 25:1351-1360.
14. Kramer, L., Tribl. B., Gendo, A., Zauner, C., Schneider, B., Ferenci, P., and Madl, C. (2000). Partial pressure of ammonia versus ammonia in hepatic encephalopathy. Hepatology 31:30-34.
15. Lockwood, A.H., Bolomey, L., and Napoleon, F. (1984). Blood-brain barrier to ammonia in humans. J. Cereb. Blood Flow Metab. 4:516-522.
16. Loguercio, C., Del Vecchio Blanco, C., and Coltorti, M. (1991). Oral ammonia load in well compensated cirrhosis: Effect on psychometric tests. In (F. Bengtsson, B. Jepsson, T. Almdal, and H. Vilstrup, eds.), Progress in Hepatic Encephalopathy and Metabolic Nitrogen Exchange, CRC Press, Boston, pp. 83-89.
17. Marchesini, G., Zoli, M., Dondi, C., Cecchini, L., Angiolini, A., Bianchi, F.B., and Pisi, E. (1980). Prevalence of subclinical hepatic encephalopathy in cirrhotics and relationship to plasma amino acid imbalance. Dig. Dis. Sci. 25:763-768.
18. Masini, A., Efrati, C., Merli, M., Attili, A.F., Amodio, P., Ceccanti, M., and Riggio, O. (1999). Effect of lactitol on blood ammonia response to oral glutamine challenge in cirrhotic patients: Evidence for an effect of nonabsorbable disaccharides on small intestine ammonia generation. Am. J. Gastroenterol. 94:3323-3327.
19. McCrea, M., Cordoba, J., Vessey, G., Blei, A.T., and Randolph, C. (1996). Neuropsychological characterization and detection of subclinical hepatic encephalopathy. Arch. Neurol. 53:758-763.
20. Oppong, K.N., Al Mardini, H., Thick, M., and Record, C.O. (1997) Oral glutamine challenge in cirrhotics pre- and post-liver transplantation: A psychometric and analyzed EEG study. Hepatology 26:870-876.
21. Posner, M.I., and Petersen, S.E. (1990). The attention system of the human brain. Annu. Rev. Neurosci. 13:25-42.
22. Posner, M.I., Walker, J.A., Friedrich, F.A., and Rafal, R.D. (1987). How do the parietal lobes direct covert attention? Neuropsychologia 25:135-145.
23. Quero, J.C., Hartmann, I.J., Meulstee, J., Hop, W.C., and Schalm, S.W. (1996). The diagnosis of subclinical hepatic encephalopathy in patients with cirrhosis using neuropsychological tests and automated electroencephalogram analysis. Hepatology 24:556-560.
24. Reitan, R.M. (1955). The relation of the Trail Making Test to organic brain damage. J Consult. Psychol. 19:393-394.
25. Reitan, R.M. (1958). Validity of the Trail Making Test as an indicator of organic brain damage. Percept. Mot. Skills 8:271-276.
26. Rikkers, L., Jenko, P., Rudman, D., and Freides, D. (1978). Subclinical hepatic encephalopathy: Detection, prevalence, and relationship to nitrogen metabolism. Gastroenterology 75:462-469.
27. Rohmer, F., and Kurtz, D. (1996). E.E.G. et ammoniémie dans les troubles nerveux des affections hépatiques, Roma, Edizione per il Congresso. Atti del 7° Congresso Internazionale di Neurologia, pp. 115-163.
28. Rose, C., Michalak, A., Pannunzio, P., Therrien, G., Quack, G., Kircheis, G., and Butterworth, R.F. (1998). L-ornithine-L-aspartate in experimental portal-systemic encephalopathy: Therapeutic efficacy and mechanism of action. Metab. Brain Dis. 13:147-157.
29. Rose, C., Michalak, A., Rao, K.V., Quack, G., Kircheis, G., and Butterworth, R.F. (1999). L-ornithine-L-aspartate lowers plasma and cerebrospinal fluid ammonia and prevents brain edema in rats with acute liver failure. Hepatology 30:636-640.
30. Stahl, J. (1963). Studies of the blood ammonia in liver disease. Its diagnostic, prognostic, and therapeutic significance. Ann. Intern. Med. 58:1-21.
31. Stauch, S., Kircheis, G., Adler, G., Beckh, K., Ditschuneit, H., Gortelmeyer, R., Hendricks, R., Heuser, A., Karoff, C., Malfertheiner, P., Mayer, D., Rosch, W., and Steffens, J. (1998). Oral L-ornithine-L-aspartate therapy of chronic hepatic encephalopathy: Results of a placebo-controlled double-blind study. J. Hepatol. 28:856-864.
32. Sternberg, S. (1966). High-speed scanning in human memory. Science 153:652-654.
33. Sternberg, S. (1969) Memory-scanning: Mental processes revealed by reaction-time experiments. Am. Sci. 57:421-457.
34. Tarter, R.E., Hegedus, A.M., Van Thiel, D.H., Schade, R.R., Gavaler, J.S., and Starzl, T.E. (1984). Nonalcoholic cirrhosis associated with neuropsychological dysfunction in the absence of overt evidence of hepatic encephalopathy. Gastroenterology 86:1421-1427.
35. Therrien, G., Giguere, J.F., and Butterworth R.F. (1991). Increased cerebrospinal fluid lactate reflects deterioration of neurological status in experimental portal-systemic encephalopathy. Metab. Brain Dis. 6:225-231.
36. Vince, A., Dawson, A.M., Park, N., and O'Grady, F. (1973). Ammonia production by intestinal bacteria. Gut 14:171-177.
37. Vogels, B.A., Karlsen, O.T., Mass, M.A., Bovee, W.M., and Chamuleau, R.A. (1997). L-ornithine vs L-ornithine-L-aspartate as a treatment for hyperammonemia-induced encephalopathy in rats. J. Hepatol. 26:174-182.
38. Zieve, L. (1981). The mechanism of hepatic coma. Hepatology 1:360-365.