CLINICAL CO RELATION BETWEEN ARTERIAL VERSUS VENOUS AMMONIA LEVELS IN HEPATIC ENCEPHLOPATHY IN CIRRHOSIS OF LIVER

Hepatic encephalopathy is a reversible neuropsychiatry state that complicates liver disease.Pathogenesis of Hepatic Encephalopathy in chronic liver is function is widely accepted to be due to failure of hepatic clearance of toxins products from gut exact toxin involved remains controversial but ammonia is thought to be an important factor.Ammonia levels help both in diagnosis and serve as a guide in treatment.Diagnosis of Hepatic Encephalopathy can be done based on clinical criteria and the severity of Hepatic Encephalopathy can be graded by West Haven Criteria.This criterion is the simplest grading of Hepatic Encephalopathy based on clinical findings.AIMS AND OBJECTIVES: To correlate between Ammonia levels and clinical severity of Hepatic Encephalopathy in Cirrhosis of liver and correlate between Arterial versus venous ammonia levels with severity of Hepatic Encephalopathy.RESULTS: Male patients had higher incidence than females.Severity of hepatic encephalopathy was graded by West Haven grading.Arterial total ammonia and venous ammonia was correlated with the clinical severity of HE.Of the 50 patients 3 had grade 1, 18 had grade 2, 22 had grade 3 and 7 had grade 4. Arterial and venous ammonia levels co related with severity of HE.The highest level of arterial ammonia was seen in grade 3 and grade 4.It was seen that other lab parameters also increased with severity of HE.But were not significant.Serum albumin was inversely co related with severity of HE.CONCLUSIONS: Arterial total ammonia correlated better with the severity of Hepatic Encephalopathy as compared to venous ammonia levels.Venous total ammonia did not correlate with severity of Hepatic Encephalopathy and with arterial ammonia levels.INTRODUCTION: Hepatic encephalopathy is a reversible neuropsychiatry state that complicates liver disease.Pathogenesis of Hepatic Encephalopathy in chronic liver is function is widely accepted to be due to failure of hepatic clearance of toxins products from gut exact toxin involved remains controversial but ammonia is thought to be an important factor.Correlation between plasma ammonia levels and severity of Hepatic Encephalopathy is not consistent, but ammonia levels are used widely in diagnosis of Hepatic Encephalopathy in cirrhotic patients.1 In a study done by Janus.P.ong it was seen that Ammonia levels increased with the severity of Hepatic Encephalopathy and that Arterial Ammonia levels correlated better with the severity as compared to Venous ammonia. 2 Ammonia levels help both in diagnosis and serve as a guide in treatment.Diagnosis of Hepatic Encephalopathy can be done based on clinical criteria and the severity of Hepatic Encephalopathy can be graded by West Haven Criteria.This criteria is the simplest grading of Hepatic Encephalopathy based on clinical findings.