Ammonia as a neuro- and hepatotoxin: clinical aspects
Ammonia is the most studied and, apparently, the most critical pathogenetic factor for hepatic encephalopathy (HE). The pathogenesis of PE is varied depending on the type of liver damage. Apart from neurotoxic properties, ammonia has general cytotoxic as well as hepatotoxic effects. A recent study allowed to register presence of hyperammonemia in patients with initial liver changes leading to latent cognitive dysfunction, which manifests itself in impaired reaction in stressful situations. Drug therapy of PE is primarily aimed at prevention and acceleration of metabolism of ammonia. Administration of ornithine metabolites reduces hyperammonemia, improves cognitive function and reduces enzyme activity, including in patients at pre-cirrhotic stage.