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What every Intensivist should know about ... Ammonia in liver failure
Tiago Duarte1, Pedro Fidalgo2, Constantine J Karvellas3
1Intensive Care Unit, Curry Cabral Hospital, Lisbon, Portugal.
Journal of Critical Care
|November 9, 2023
Summary
Serum ammonia levels are crucial in managing liver failure, impacting neurological outcomes and infection risk. Targeted therapies can effectively manage hyperammonemia in acute liver failure (ALF) and acute-on-chronic liver failure (ACLF) patients.
Area of Science:
- Hepatology
- Critical Care Medicine
- Neuroscience
Background:
- Acute liver failure (ALF) and acute-on-chronic liver failure (ACLF) are associated with high short-term mortality.
- Elevated serum ammonia in liver failure correlates with severe neurological complications like hepatic encephalopathy (HE), cerebral edema, and intracranial hypertension.
- Hyperammonemia can also impair immune function, increasing infection risk and multi-organ failure in critically ill liver patients.
Purpose of the Study:
- To review recent insights into ammonia metabolism and its clinical significance in liver failure.
- To explore the prognostic value of serum ammonia levels.
- To discuss ammonia-targeted therapeutic strategies for patients with ALF and ACLF.
Main Methods:
- A literature-based narrative review was conducted.
- Publications were sourced from PubMed® up to June 2023.
Main Results:
- Serum ammonia measurement is important for ICU management of liver failure patients.
- Hyperammonemia has significant prognostic value in liver failure.
- Recent insights into ammonia metabolism, measurement, and therapeutic strategies were analyzed.
Conclusions:
- Serum ammonia levels can serve as a prognostic indicator in liver failure.
- Effective ammonia-targeted therapies, including laxatives, rifaximin, L-ornithine-L-aspartate, and continuous renal replacement therapy, are available.
- Management strategies should consider the role of ammonia in liver failure outcomes.
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