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SERUM AMMONIA LEVELS AS A PREDICTOR FOR SEVERITY OF HEPATIC ENCEPHALOPATHY

Dr. Munazza Iftikhar, Dr. Nokhaiz Khanam, Muhammad Furqan Sharif

Objective: To assess the correlation between serum ammonia levels with the severity of Hepatic Encephalopathy (HE) in patients visiting to the tertiary care hospital with advance liver disease. Methodology: This is a Descriptive, analytical study conducted at Jinnah Hospital Lahore from May 2019 to November 2019. A total of 50 patients with liver cirrhosis and HE had serum ammonia levels checked at presentation of patient. The diagnosis of HE was constructed on clinical criteria, and its severity was graded according to the “West Haven Criteria for grading of mental status”. Ammonia levels were correlated with the severity of HE using Spearman rank correlation. Results: Out of 15 patients with normal ammonia levels, 8 (53.3%) were in hepatic encephalopathy grade I and II, 5 (33%) were in grade-III, while 2 (13.33%) patient were in grade-IV hepatic encephalopathy. Out of 22 patients with mildly raised ammonia levels, 6 (27.27%) were having grade I-II encephalopathy, 4 (18.18%) were in grade-III and 12 (54.54%) were having grade-IV HE. Out of 4 patients with moderate hyperammonemia, 1 (25%) was in grade II, 2 (50%) were in grade-III, and 1 (25%) were in grade-IV HE. Out of 9 patients with severe hyperammonemia, 6 (66.67%) patients were in grade-IV. Conclusion: Serum ammonia levels correlated with the severity of hepatic encephalopathy. Increased ammonia level, severe is the grade of hepatic encephalopathy. Key Words: Ammonia. Hepatic encephalopathy. Cirrhosis. Hyperammonemia.