[Differences in plasma aminograms in hepatic and diabetic coma]

Area of Science:

• Biochemistry
• Metabolic Disorders
• Clinical Chemistry

Background:

• Hepatic coma and diabetic coma involve severe amino acid metabolism disturbances.
• These conditions result in distinct plasma aminograms (PAG) due to defects at different metabolic levels.
• Understanding these differences is crucial for diagnosing and managing metabolic encephalopathies.

Purpose of the Study:

• To evaluate plasma amino acid profiles (PAG) in patients with hepatic encephalopathy (stage III-IV).
• To compare amino acid metabolism disturbances in hepatic coma versus diabetic coma.
• To investigate the correlation between amino acid quotients and the severity of metabolic encephalopathy.

Main Methods:

• Analysis of plasma amino acids (PAA) in 24 patients with hepatic encephalopathy (acute and chronic liver failure).
• Utilized Multichrom B (Beckmann, Munich) for PAA determination.
• Calculated the quotient between branched-chain and aromatic amino acids for comparison.

Main Results:

• Hepatic coma shows elevated concentrations of methionine (Met), tyrosine (Tyr), alanine (Ala), lysine (Lys), and arginine (Arg).
• Diabetic coma exhibits 3-5 fold increases in branched-chain amino acids (Val, Leu, Ile) with near-normal levels of other amino acids.
• The branched-chain to aromatic amino acid quotient is significantly higher in diabetic coma (7.18) than in hepatic coma (1.18) (p < 0.001).

Conclusions:

• Distinct plasma aminograms differentiate hepatic and diabetic coma.
• A high branched-chain to aromatic amino acid quotient in diabetic coma correlates with the rarity of unconsciousness.
• Improvements in the amino acid quotient correlate with decreased metabolic encephalopathy severity in hepatic coma.