Hepatic encephalopathy branched-chain amino acids

Bombardieri, G., Gigli, G.L., Bern di, L., Ferri, R., Grass , C., Milani, A. Visual evoked potential recordings in hepatic encephalopathy and their variations during branched chain amino-acid treatment. Hepato-Gastroenterol. 1985 32 3—7... 

Eriksson, L.S., Conn, H.O. Branched-chain amino acids in the management of hepatic encephalopathy an analysis of variants. Hepatology 1989 10 228 - 246... 

Freund, H., Yoshimura, N., Fischer, J.E. Chronic hepatic encephalopathy. Long-term therapy with a branched-chain amino-acid-enriched elemental diet. X. Amer. Med. Ass. 1979 242 347-349... 

Higuchi, K., Shimizu, Y., Nambu, S., Miyabayashi, C., Takahara, T., Saito, S., Hioki, O., Kuwabara, Y., Watanabe, A. Effects of an infusion of branched-chain amino acids on neurophysiological and psychometric testings in cirrhotic patients with mild hepatic encephalopathy. 

Naylor, C.D., O Rourke, K., Detsky, A.S., Baker, J.R Parenteral nutrition with branched-chain amino acids in hepatic encephalopathy. A meta-analysis. Gastroenterology 1989 97 1033-1042... 

The cirrhosis patient is in a vicious circle regarding protein metabolism cirrhosis hepatic encephalopathy protein restriction malnutrition catabolism Thus, prolonged protein restriction and catabolism may considerably worsen the prognosis of cirrhosis. In this hazardous situation, the dietary and therapeutic use of branched-chain amino acids (BCAA), i.e. valine, leucine and isoleucine, is a logical therapeutic intervention. 

Fabbri, A., Marini, N., Bianchi, G., Zoli, M., Marchesini, G. Overview of randomized clinical trials of oral branched-chain amino acid treatment in chronic hepatic encephalopathy. J. Parenter. Enter. Nutr. 1996 20 159-164... 

Ichida, T., Shibasaki, K., Muto, Y., Satoh, S., Watanabe, A., Ichida, F. Clinical study of an enteral branched-chain amino acid solution in decompensated liver cirrhosis with hepatic encephalopathy. Nutrition 1995 11 (Suppl. 2) 238 - 244... 

Als-Nielsen B, Koretz RL, Kjaergard LL, Gluud C. Branched-chain amino acids for hepatic encephalopathy. Cochrane Database Syst Rev 2003 2 CD001939. 

Because the hver metabohzes the aromatic amino acids (i.e., phenylalanine, tyrosine, and tryptophan), methionine, and glutamine, the plasma concentrations of these amino acids are elevated in cirrhotic patients. Plasma concentrations of the branched-chain amino acids (BCAAs) (i.e., valine, leucine, and isoleucine) often are depressed because these amino acids are metabohzed by skeletal muscle. This altered plasma aminogram contributes to the development of hepatic encephalopathy. 

An altered plasma amino acid pattern is observed in patients with liver cirrhosis and hepatic encephalopathy low concentrations of the branched-chain amino acids (leucine, valine, and isoleucine) and high levels of... 

Wahren, J., Denis, J., Desurmont, P., Eriksson, L. S., Escoffier, J. M., Gauthier, A. P., Hagenfeldt, L., Michel, H., Opolon, P., Paris, J. C., and Veyrac, M., Is intravenous administration of branched-chain amino acids effective in the treatment of hepatic encephalopathy A multicenter study, Hepatology, 3, 475,1983. 

Hepatic Increased branched-chain and decreased aromatic amino acids Patients with hepatic encephalopathy. 

Crystalline amino acid bulk solutions are supplied by various manufacturers in various concentrations (e.g., 3.5%, 5%, 7%, 8.5%, 10%, 15%, and 20%). Different formulations are tailored for specific age groups (e.g., adults and infants) and disease states (e.g., renal and liver disease). Specialized formulations for patients with renal failure contain higher proportions of essential amino acids. Formulas for patients with hepatic encephalopathy contain higher amounts of branched-chain and lower amounts of aromatic amino acids. However, these specialized formulations should not be used routinely in clinical practice because their efficacy has not been clearly demonstrated. Crystalline amino acid solutions have an acidic pH (pH = 5-7) and may contain inherent electrolytes (e.g., sodium, potassium, acetate, and phosphate). 

Freund, H., Dienstag, J., Lehrich, J., Yoshimura, N., Bradford, R. R., Rosen, H., Atamian, S., Slemmer, E., Holroyde, J., and Fischer, J. E., Infusion of branched-chain enriched amino acid solution in patients with hepatic encephalopathy, Ann. Surg., 196, 209, 1982. 

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