Indocyanine green clearance and ammonia tolerance in partially hepatectomized and hepatic devascularized,...

Indocyanine green clearance and ammonia tolerance were measured in anesthetized dogs with 60% hepatectomy, 40% hepatectomy, portacaval shunt, and hepatic artery ligation. With a dose of 0.5 mg of indocyanine green/kg of body weight, plasma clearance of the dye was significantly (P less than 0.001) delayed only in dogs with 60% hepatectomy. Ammonia tolerance was abnormal in dogs in this group, because after they were given a gastric challenge load of an ammonium salt, they had a 5-fold increase in plasma ammonia concentration, compared with a 2.5-fold increase in the control group. Before challenge loading, base-line plasma ammonia concentration was significantly (P less than 0.05) increased within 5 minutes after surgical preparation of the portacaval shunt. After challenge loading the stomach with an ammonium salt, dogs with portacaval shunt had increased plasma ammonia concentration, but the amount was not significantly different from postchallenge-loading values in control dogs. Dogs with 40% hepatectomy and with hepatic artery ligation could not be differentiated from control dogs by indocyanine green clearance or by ammonia tolerance testing. Abnormal tolerance to a challenge gastric load of an ammonium salt or delayed clearance of indocyanine green may indicate marked loss of functional hepatic mass, but normal tolerance or normal dye clearance may not exclude liver disease or dysfunction. Seemingly, base-line plasma ammonia concentration was a sensitive indicator of abnormal portal circulation.(ABSTRACT TRUNCATED AT 250 WORDS)