During liver insufficiency, besides portasystemic shunting, high arterial glutamine concentrations could enhance intestinal glutamine consumption and ammonia generation, thereby aggravating hyperammonaemia. To investigate this hypothesis, portal drained viscera (intestines) fluxes and jejunal tissue concentrations of ammonia and glutamine were measured in portacaval shunted rats with a ligated bile duct, portacaval shunted, and sham operated rats, seven and 14 days after surgery, and in normal unoperated controls. Effects of differences in food intake were minimised by pair feeding portacaval shunted and sham operated with portacaval shunted rats with biliary obstruction. At both time points, arterial ammonia was increased in the groups with liver insufficiency. Also, arterial glutamine concentration was raised in ali operated groups compared with normal unoperated controls. At both time points, ammonia production by portal drained viscera was reduced in portacaval shunted rats with biliary obstruction, portacaval shunted, and sham operated rats compared with normal unoperated controls, and no major differences were found between these operated groups. At day 7 in ali operated groups glutamine uptake by portal drained viscera was lower than in normal unoperated controls, but no major differences were found at day 14. These experiments show that ammonia generation by portal drained viscera remains unchanged in rats with chronic liver insufficiency despite alterations in arterial glutamine concentrations and intestinal glutamine uptake. The hyperammonaemia seems to be mainly determined by the portasystemic shunting. (Gut 1993; 34: 24 November 1992 Ammonia is still considered to be of crucial importance in the pathogenesis of hepatic encephalopathy.' The gut and kidney are generally considered to be the most important sites of ammonia production.2'-In the gut, the main sources of ammonia production are the bacterial breakdown of urea2 367 and the mucosal utilisation of glutamine as an energy substrate.2 37I In the physiological situation virtually all ammonia generated in the gut is immediately cleared by hepatic urea synthesis, and thus hepatic venous ammonia concentrations are lower than arterial concentrations. Therefore, in healthy subjects, systemic ammonia concentrations are probably mainly set by the interaction between renal ammonia production and ammonia consumption by other organs. During liver cirrhosis induced by chronic liver disease this situation changes drastically, because ammonia generated in the intestines bypasses hepatic clearance by intra or extrahepatic portasystemic shunts.910 Also, the diminished urea synthesis and glutamine synthetase capacity9' may reduce ammonia detoxification in the liver. These combined factors probably cause the systemic hyperammonaemia found during liver insufficiency.It has been suggested that systemic hyperammonaemia during chronic liver failure leads to enhanced ammonia detoxification via alternative pathways.'2 It is generally believed that the ener...