Disease‐Specific Amino Acid Infusion (F080) in Hepatic Encephalopathy: A Prospective, Randomized, Double‐Blind, Controlled Trial

Abstract

Seventy-five patients with acute hepatic decompensation superimposed on chronic alcoholic cirrhosis were prospectively randomized for a blinded trial of the treatment of hepatic encephalopathy. The control group received 4 g of enteral neomycin daily along with 25% dextrose by a central venous catheter. The experimental group received a placebo resembling neomycin and isocaloric dextrose plus a modified amino acid mixture enriched with branched-chain amino acids to 36% and deficient in aromatic amino acids and methionine. Thirty patients in the F080 group and 29 in the control group completed the trial. The group receiving the modified amino acid mixture demonstrated a statistically significant improvement in encephalopathy as compared to the neomycin group, while maintaining nitrogen equilibrium. Survival and discharge from the hospital were statistically greater in the group treated with the modified amino acid solution and hypertonic dextrose. Treatment of hepatic encephalopathy in the presence of hepatic decompensation with an amino acid solution formulated for its treatment seems to produce faster, more complete recovery with improved capacity for nutritional support.

The Plasma Amino Acid Profile and its Relationships to Standard Quantities of Liver Function in Infants and Children with Extrahepatic Biliary Atresia and Preterminal Liver Cirrhosis

“…We therefore conclude that in children with extrahepatic biliary atresia and cirrhosis, the valine/tyrosine ratio and the Fischer index are good indicators of hepatic synthetic capacity, that plasma tyrosine concentration correlates with estimated hepatic blood flow and with cholestasis, and that these indicators and the plasma amino acid profile should be used in the biochemical and nutritional (35,40) evaluation of patients awaiting liver transplantation.…”

“…In calorie deprivation branched chain amino acids may become a source of fuel for muscle (19,33,34). We postulate that in our extrahepatic biliary atresia children the branched chain amino acids deficit resulted from their use as alternative energy substrates, and that the low concentrations of these amino acids may indicate increased dietary requirements for them (35).…”

Malnutrition Syndromes: A Conundrum vs Continuum

“…There are, however, exceptions, and in earlier studies, hypertonic dextrose in substantial amounts without protein was provided to control groups in trials of total parenteral nutrition that encompassed patients with a variety of disorders, including renal failure and hepatic failure, and postoperatively. [45][46][47] Interestingly, the mortality was significantly worsened in the control groups of each of these studies. These findings do lend credence to the particularly undesirable consequences of adequate energy without protein during moderate to severe degrees of systemic inflammation.…”

Advances in cirrhosis: Optimizing the management of hepatic encephalopathy

“…Randomized controlled trials have evaluated the use of BCAArich parenteral nutrition in patients with HE [41,42] . Based on a metaanalysis, patients receiving BCAArich infusions demonstrated superior mental recovery compared to controls [43] .…”