7. Overview on treatments

The treatment HE resonates around decreasing ammonia. It can be achieved through three major mechanisms: decreasing ammoniagenic substrates, inhibiting ammonia production, and metabolic removal of ammonia (Table 2).

#### 7.1 Decreasing ammoniagenic substrates: enemas

Enemas are the main treatment of this category. These are administered to patients at increased risk of aspiration. Different agents have been used, including


#### Table 2.

Proteus mirabilis), ureterosigmoidostomy, parenteral nutrition, high-dose chemotherapy, and systemic Mycoplasma hominis or Ureasplasma spp. infection in lung

affecting the muscles such as severe muscle exertion/heavy exercise are worth

Reduced participation of liver in the removal of ammonia may occur in any cause of portosystemic shunting of blood, such as in hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu disease) and portal hypertension with collateral

Two other groups of conditions are considered controversial in their role in the development of hyperammonemia: congenital disorders (certain inborn errors of metabolism such as urea cycle defects and organic acidemia) and medication induced (valproic acid, barbiturates, narcotics, diuretics, alcohol, and salicylate-Reye syndrome). Some authors classify both as a cause for hyperammonemia while others would englobe in subgroups of liver diseases as they are believed to have

The treatment HE resonates around decreasing ammonia. It can be achieved through three major mechanisms: decreasing ammoniagenic substrates, inhibiting

Enemas are the main treatment of this category. These are administered to patients at increased risk of aspiration. Different agents have been used, including

ammonia production, and metabolic removal of ammonia (Table 2).

7.1 Decreasing ammoniagenic substrates: enemas

Within the conditions that decrease extrahepatic removal of ammonia, diseases

transplant recipients.

Liver Disease and Surgery

Differential diagnosis for elevated ammonia levels.

similar pathophysiology [19, 20].

7. Overview on treatments

noting.

Table 1.

formation.

30

Mechanisms used in treatment of hyperammonemia.

tap water, milk/molasses, and lactulose. The efficacy of enema administration has not been evaluated [19].
