Role of Sustained Low-Efficiency Dialysis (SLED) in HyperammoniaPatients with Hepatic Encephalopathy

1to severe .The advancement of hepatic encephalopathy to grade 3 or 4 is characterized by impairment of consciousness.A number of chemicals, including ammonia, are 2 neurotoxic and reduce excitatory neurotransmission .Ammonia can also pass across the blood-brain barrier, where astrocytic glutamine synthetase transforms ammonia and glutamate into glutamine, which raises cerebral volume through osmosis, resulting in neuronal dysfunction and cerebral edema, 3 particularly in patients with no prior liver failure .Of patients with hepatic encephalopathy, up to 80% had elevated serum ammonia levels.Furthermore, concurrent renal failure might result in further hyperammonemia because the kidneys eliminate 20% of body's ammonia.Even though blood level of ammonia does not have a defined threshold that is correlated with the presence of neurological 4 5 symptoms , arterial ammonia levels <75 mol/L or <128 g/dl (range = 6-47 mol/L or 10-80 g/dL) are Abstract Objective: To assess the role of sustained low-efficiency dialysis (SLED) in patients with hyperammonia secondary to liver failure. Methods:In this retrospective study, 20 patients with hepatic encephalopathy from hyperammonia secondary to liver failure (14 with ACLF and 6 with ALF) were offered SLED.The study excluded pediatric patients and those with normal ammonia or without hepatic encephalopathy.Data collected included demographics, diagnosis, lab results, APACHE II/SOFA scores, and outcomes.Ammonia levels were monitored before and during SLED.Success was defined by ammonia reduction and clinical improvement.The SLED protocol used a 300 mL/min dialysate flow, 100-200 mL/min blood flow, and ultrafiltration of 0-2500 mL/session for 6-8 hours daily.SLED was stopped when ammonia remained <145 g/dL (85 mol/L) twice, 12-24 hours apart, with neurological improvement. Results:The mean age was 41 14.5.A total of 9 patients survived (3 ALF and 6 ACLF) with an overall mortality rate of 55%.Low Hb, albumin and high SOFA scores were found to be poor prognostic markers. Conclusion:Hyperammonia causing hepatic encephalopathy in liver failure carries a high mortality rate and requires prompt lowering of the ammonia level to prevent brain damage.SLED can be considered in lowering ammonia level.Large-scale studies are required to further assess efficacy of SLED in treating hyperammonia.