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Intravenous and Oral Hyperammonemia Management

  • Pharmacology of Acute Care (J Fanikos, Section Editor)
  • Published:
Current Emergency and Hospital Medicine Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Hyperammonemia have significant morbidity and mortality. In this paper, we reviewed the latest research and evidence of both conventional and upcoming oral or intravenous treatments.

Recent Findings

New updates on the role of oral agents such as rifaximin, PEG, probiotics, glycerol phenylbutyrate, and zinc supplements in the management of both chronic hyperammonemia and overt hepatic encephalopathy have been discussed in this review. We discussed the recent findings on the role of branched-chain amino acids in patients with cirrhosis.

Summary

Rifaximin role has expanded as mono or combination therapy in patients with hepatic encephalopathy. Probiotics and zinc might play a role in the prevention of overt hepatic encephalopathy. Newer oral agents such as activated carbon seem to be promising. Saline or albumin might play a role in diuretic-induced hyperammonemia but their role is yet to be determined. More research is needed for new interventions and treatment validation.

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Abbreviations

ASL:

Argininosuccinic acid lyase

ASS:

Argininosuccinate synthetase

ATP:

Adenosine 5′-triphosphate

BBB:

Blood-brain barrier

BCAA:

Branch chain amino acids

CPS:

Carbamyl phosphate synthetase

CT:

Computed tomography

GI:

Gastrointestinal

ICH:

Intracranial hemorrhage

IEM:

Inborn error of metabolism

IV:

Intravenous

LOLA:

L-Ornithine-L-aspartate

MRI:

Magnetic resonance imaging

NAGS:

N-Acetyl glutamine synthetase

OTC:

Ornithine transcarbamylase

RRT:

Renal replacement therapy

TPN:

Total parenteral nutrition

UCDs:

Urea cycle disorders

US:

Ultrasonography

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  1. Pharmacy Division, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA, 02115, USA

    Abdulrahman Alshaya, John Fanikos & Elizabeth DeMaio

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Alshaya, A., Fanikos, J. & DeMaio, E. Intravenous and Oral Hyperammonemia Management. Curr Emerg Hosp Med Rep 6, 182–193 (2018). https://doi.org/10.1007/s40138-018-0174-5

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