Co-relation of high serum ammonia levels with severity of hepatic encephalopathy in chronic liver disease patients

Objective: To assess co-relation of high serum ammonia levels with severity of hepatic encephalopathy in chronic liver disease patients. Methodology: This study was conducted at Department of Medicine, Civil Hospital Karachi, from April 2, 2012 to October 1, 2012. Using West Heaven Criteria mental status was assessed and serum ammonia level was determined at the time of admission. All patients of age above 18 years of either gender with chronic liver disease presenting with altered mental status were included in study. Patient age less than 18 years, had mental status changes due to cause other than hepatic encephalopathy i.e. metabolic encephalopathy, intracranial lesion, multi organ failure, previously diagnosed psychiatric illness, history of substance abuse, were excluded. Results: There were 30 (58.8%) males and 21 (41.2%) females. Hepatitis C was the cause of CLD in 40 (78.4%), hepatitis C & B in 5 (9.8%) and alcoholic liver in 6 (11.8%) patients (p=0.088). Constipation was the precipitating factor in 24 (47.1%), upper GI bleed 14 (27.5%), infection 12 (23.5%) and SBP in one (2%) (p=0.658). Four (7.8%) had grade 1, 21 (41.2%) grade 2, 18 (35.3%) grade 3 and 08 (15.7%) had grade 4 hepatic encephalopathy (p=0.150). The mean serum ammonia level of patients with grade 1 HE was 178.3 +/- 58.9, grade two 220.9 +/- 82.6, grade three 213.2 +/- 62.9 and grade four 252.1 +/- 87.7 (p=0.389). There was weak correlation with severity of hepatic encephalopathy (rs=0.144). Conclusion: Ammonia levels weekly correlated with the severity of hepatic encephalopathy. HE is commonly precipitated by constipation and upper GI bleed and hepatitis C virus was the commonest cause of cirrhosis in these patients.