Can Blood Levels of Ammonia Predict Risk and Frequency of Hepatic Encephalopathy in Patients With Cirrhosis?
We have long argued about the benefits of ammonia levels in following patients with cirrhosis and altered mentation. The textbook answer, long “re-posted”, is that the levels are not useful. But, whenever we follow recommendations historically and by habit–without thinking about the underlying rationale–we are at risk of getting burned. So it may be with ammonia levels. Let’s look at this issue with a fresh eye.
Vierling et al., propose that fasting ammonia is useful in predicting encephalopathy related morbidity and that patients with chronic liver disease might benefit from strategies to reduce plasma ammonia levels.