Hepatic encephalopathy laboratory findings: Difference between revisions
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==Laboratory Findings== | ==Laboratory Findings== | ||
The normal [[plasma]] level of [[ammonia]] is 12 - 48 μmol/L.<ref name="pmid9761809">{{cite journal |author=Kratz A, Lewandrowski KB |title=Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Normal reference laboratory values |journal=N Engl J Med |volume=339 |issue=15 |pages=1063 |year=1998 |pmid9761809=|doi=10.1056/NEJM199810083391508 |url=http://content.nejm.org/cgi/content/full/339/15/1063/ |issn=}}</ref> | The normal [[plasma]] level of [[ammonia]] is 12 - 48 μmol/L.<ref name="pmid9761809">{{cite journal |author=Kratz A, Lewandrowski KB |title=Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Normal reference laboratory values |journal=N Engl J Med |volume=339 |issue=15 |pages=1063 |year=1998 |pmid9761809=|doi=10.1056/NEJM199810083391508 |url=http://content.nejm.org/cgi/content/full/339/15/1063/ |issn=}}</ref> | ||
A study in 2019 found that elevated plasma ammonia (≥79.5 µmol/L) predicted HE grade 3 or more<ref name="pmid30703853">{{cite journal| author=Sheikh MF, Mookerjee RP, Agarwal B, Acharya SK, Jalan R| title=Prognostic Role of Ammonia in Cirrhotic Patients. | journal=Hepatology | year= 2019 | volume= | issue= | pages= | pmid=30703853 | doi=10.1002/hep.30534 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30703853 }} </ref>. | |||
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Latest revision as of 04:04, 26 February 2019
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Mohamadmostafa Jahansouz M.D.[2]
Overview
An elevated/reduced concentration of serum/blood/urinary/CSF/other [lab test] is diagnostic of [disease name].
OR
Laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].
OR
[Test] is usually normal among patients with [disease name].
OR
Some patients with [disease name] may have elevated/reduced concentration of [test], which is usually suggestive of [progression/complication].
OR
There are no diagnostic laboratory findings associated with [disease name].
Laboratory Findings
The normal plasma level of ammonia is 12 - 48 μmol/L.[1] A study in 2019 found that elevated plasma ammonia (≥79.5 µmol/L) predicted HE grade 3 or more[2].
| NH3 level | Grade 0 (no encephalopathy) |
Grade 1 | Grade 2 | Grade 3 | Grade 4 |
|---|---|---|---|---|---|
| > 50 | 10 (33%) | 18 (67%) | 14 (52%) | 25 (89%) | 12 (92%) |
| 25-20 | 12 (40%) | 9 (33%) | 5 (19%) | 3 (11%) | 0 |
| < 25 | 8 (27%) | 0 (0%) | 4 (15%) | 0 (0)%) | 1* (8%) |
| Total patients |
30 (100%) | 27 (100%) | 2 (100%)3 | 28 (100%) | 13 (100%) |
| *This patient's ammonia level was approximately 20 μmol/L. | |||||
The ammonia level can help diagnose encephalopathy[3][4][5] although its ability is less clear in chronic liver disease[6].
| Venous ammonia levels | Sensitivity | Specificity |
|---|---|---|
| > 50 μmol/L | 76% | 67% |
| > 25 μmol/L | 93% | 27% |
Ammonia levels over 123 are likely to improve with lactulose therapy.[7]
An ammonia level more than 200 strongly suggests hepatic encephalopathy.[3]
Other important laboratory findings in hepatic encephalopathy may include:
- Anemia is a predictor of hepatic encephalopathy in some patients with hepatic cirrhosis.[10]
- Liver function tests: patients may have abnormal bilirubin, albumin, AST, ALT, AST/ALT, INR due to underlying hepatic disease.[11]
- Hypercreatinemia may be present in patients with end-stage liver disease.[12]
References
- ↑ Kratz A, Lewandrowski KB (1998). "Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Normal reference laboratory values". N Engl J Med. 339 (15): 1063. doi:10.1056/NEJM199810083391508.
- ↑ Sheikh MF, Mookerjee RP, Agarwal B, Acharya SK, Jalan R (2019). "Prognostic Role of Ammonia in Cirrhotic Patients". Hepatology. doi:10.1002/hep.30534. PMID 30703853.
- ↑ 3.0 3.1 3.2 3.3 Ong JP, Aggarwal A, Krieger D; et al. (2003). "Correlation between ammonia levels and the severity of hepatic encephalopathy". The American journal of medicine. 114 (3): 188–93. PMID 12637132. Unknown parameter
|month=ignored (help) - ↑ Stahl J (1963). "Studies of the blood ammonia in liver disease. Its diagnostic, prognostic, and therapeutic significance". Annals of internal medicine. 58: 1–24. PMID 13978712. Unknown parameter
|month=ignored (help) - ↑ Nicolao F, Efrati C, Masini A, Merli M, Attili AF, Riggio O (2003). "Role of determination of partial pressure of ammonia in cirrhotic patients with and without hepatic encephalopathy". Journal of hepatology. 38 (4): 441–6. PMID 12663235. Unknown parameter
|month=ignored (help) - ↑ Ge PS, Runyon BA (2014). "Serum ammonia level for the evaluation of hepatic encephalopathy". JAMA. 312 (6): 643–4. doi:10.1001/jama.2014.2398. PMID 25117134.
- ↑ Sharma P, Sharma BC, Sarin SK (2009). "Predictors of nonresponse to lactulose for minimal hepatic encephalopathy in patients with cirrhosis". Liver Int. 29 (9): 1365–71. doi:10.1111/j.1478-3231.2009.02067.x. PMID 19555401.
- ↑ Yun BC, Kim WR (2009). "Hyponatremia in hepatic encephalopathy: an accomplice or innocent bystander?". Am J Gastroenterol. 104 (6): 1390–1. doi:10.1038/ajg.2009.287. PMID 19455127.
- ↑ Gaduputi V, Chandrala C, Abbas N, Tariq H, Chilimuri S, Balar B (2014). "Prognostic significance of hypokalemia in hepatic encephalopathy". Hepatogastroenterology. 61 (133): 1170–4. PMID 25436277.
- ↑ Kalaitzakis E, Josefsson A, Castedal M, Henfridsson P, Bengtsson M, Andersson B; et al. (2013). "Hepatic encephalopathy is related to anemia and fat-free mass depletion in liver transplant candidates with cirrhosis". Scand J Gastroenterol. 48 (5): 577–84. doi:10.3109/00365521.2013.777468. PMID 23452072.
- ↑ Djiambou-Nganjeu H (2017). "Hepatic Encephalopathy in Liver Cirrhosis". J Transl Int Med. 5 (1): 64–67. doi:10.1515/jtim-2017-0013. PMC 5490964. PMID 28680841.
- ↑ Hartleb M, Gutkowski K (2012). "Kidneys in chronic liver diseases". World J Gastroenterol. 18 (24): 3035–49. doi:10.3748/wjg.v18.i24.3035. PMC 3386317. PMID 22791939.