Effects of High-Volume Plasmapheresis on Ammonia, Urea, and Amino Acids in Patients With Acute Liver Failure

• DOI: 10.1111/j.1572-0241.2001.03706.x
• Publication Date: 2004-03-29T10:45:50Z
• Authors: Jens Otto Clemmesen; Jens Kondrup; Lars Bo Nielsen; Fin Stolze Larsen; Peter Ott
• Keywords: Hepatic Encephalopathy; Hyperammonemia; Ammonia production

OBJECTIVE: In acute liver failure (ALF), urea production is severely impaired, and detoxification of ammonia by glutamine synthesis plays an important protective role. The aim this study was to examine the effects therapeutic high-volume plasmapheresis (HVP) on arterial concentrations splanchnic exchange rates ammonia, urea, amino acids—in particular, glutamine. METHODS: A quantity 8 L plasma exchanged over course 7 h in 11 patients with ALF after development hepatic encephalopathy grade III–IV. Splanchnic acids were measured use vein catheterization. RESULTS: HVP removed at a rate 1 μmol/min 27 μmol/min, respectively. Arterial decreased from 160 ± 65 114 50 μmol/L (p < 0.001). contrast, only minimally changed 1791 1655 1764 1875 (NS). This implied that systemic increased μmol/min. (before vs HVP) as follows: for −93 101 versus− 70 80 (NS); urea-nitrogen, 0.08 1.64 0.31 0.45 mmol/min alanine, −73 151 versus 12 83 0.05); glutamine: 132 246 186 285 (NS), negative values denoting release. CONCLUSIONS: during ALF. data suggest effect could be explained possibly muscle tissue.