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document
Effect of L-ornithine-L-aspartate on patients with and without TIPS undergoing glutamine challenge : a double blind , placebo controlled trial . BACKGROUND AND AIM An oral glutamine load in cirrhotic patients awaiting liver transplantation was shown to cause a rise in blood ammonia and psychometric abnormalities which were reversed by hepatic transplantation . L-Ornithine-L-aspartate ( LOLA ) has been shown to reduce ammonia and improve psychometric function in patients with hepatic encephalopathy . The aim of the present study was to assess the effect of LOLA in healthy patients with cirrhosis and no evidence of clinical encephalopathy after challenging the central nervous system by administration of oral glutamine . PATIENTS AND METHODS Eight cirrhotics ( Child 's B or C ) without transjugular intrahepatic portosystemic shunts ( TIPS ) and seven with TIPS underwent two oral glutamine ( 20 g ) challenges , receiving LOLA ( 5 g intravenously ) on one occasion and placebo on the other in random order . Psychometric tests , including choice reaction time ( CRT ) and number connection test , were performed before and after glutamine , together with electroencephalography and blood ammonia . RESULTS Mean basal ammonia was 27 ( SEM 5 ) micromol/l in non-TIPS and 76 ( 10 ) micromol/l in TIPS patients ( p < 0.05 ) . Basal CRT 2 was 0.643 ( 0.033 ) s in non-TIPS and 0.825 ( 0.076 ) s in TIPS patients ( p < 0.02 ) . In non-TIPS patients , ammonia increased to 36 ( 10 ) micromol/l when LOLA was administered and to 62 ( 13 ) micromol/l with placebo ( p < 0.02 ) . There was no alteration in psychometric function in non-TIPS patients after glutamine when LOLA was given but when placebo was given , glutamine caused prolongation of CRT ( p=0.02 ) . Glutamine did not affect psychometric function in TIPS patients with or without LOLA . CONCLUSION This study showed that LOLA ameliorated the deleterious psychometric effects of glutamine in Child 's grade B and C patients with cirrhosis without TIPS and supports its use in clinical practice in hepatic encephalopathy .
4295
Intervention_Pharmacological
L-ornithine-L-aspartate
4296
Intervention_Pharmacological
L-Ornithine-L-aspartate ( LOLA )
4297
Intervention_Pharmacological
LOLA
4298
Intervention_Pharmacological
oral glutamine ( 20 g ) challenges
4299
Intervention_Pharmacological
LOLA
4300
Intervention_Control
placebo
4301
Intervention_Pharmacological
LOLA
4302
Intervention_Pharmacological
LOLA
4303
Intervention_Control
placebo
4304
Intervention_Pharmacological
LOLA
4305
Outcome_Physical
blood ammonia
4306
Outcome_Physical
psychometric abnormalities
4307
Outcome_Physical
ammonia
4308
Outcome_Mental
psychometric function
4309
Outcome_Physical
Mean basal ammonia
4310
Outcome_Physical
Basal CRT 2
4311
Outcome_Physical
ammonia
4312
Outcome_Mental
psychometric function
4313
Outcome_Physical
CRT
4314
Outcome_Mental
psychometric function
4315
Outcome_Mental
psychometric effects
4316
Participant_Condition
patients with and without TIPS undergoing glutamine challenge :