
Health Dictionary
Reliable, easy-to-read patient information on common medical conditions — written in plain language, free of jargon, and grounded in current evidence. Browse the most frequent diagnoses, understand what they mean for everyday life, and learn which steps and questions help you have a focused conversation with your doctor.
Hepatic encephalopathy laboratory findings
Introduction
Overview
Overview
An elevated/reduced concentration of serum/blood/urinary/CSF/other [lab test] is diagnostic of [disease name].
OR
Laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].
OR
[Test] is usually normal among patients with [disease name].
OR
Some patients with [disease name] may have elevated/reduced concentration of [test], which is usually suggestive of [progression/complication].
OR
There are no diagnostic laboratory findings associated with [disease name].
Laboratory Findings
Laboratory Findings
The normal plasma level of ammonia is 12 – 48 μmol/L.[1] A study in 2019 found that elevated plasma ammonia (≥79.5 µmol/L) predicted HE grade 3 or more[2].
| NH3 level | Grade 0 (no encephalopathy) |
Grade 1 | Grade 2 | Grade 3 | Grade 4 |
|---|---|---|---|---|---|
| > 50 | 10 (33%) | 18 (67%) | 14 (52%) | 25 (89%) | 12 (92%) |
| 25-20 | 12 (40%) | 9 (33%) | 5 (19%) | 3 (11%) | 0 |
| < 25 | 8 (27%) | 0 (0%) | 4 (15%) | 0 (0)%) | 1* (8%) |
| Total patients |
30 (100%) | 27 (100%) | 2 (100%)3 | 28 (100%) | 13 (100%) |
| *This patient’s ammonia level was approximately 20 μmol/L. | |||||
The ammonia level can help diagnose encephalopathy[3][4][5] although its ability is less clear in chronic liver disease[6].
| Venous ammonia levels | Sensitivity | Specificity |
|---|---|---|
| > 50 μmol/L | 76% | 67% |
| > 25 μmol/L | 93% | 27% |
Ammonia levels over 123 are likely to improve with lactulose therapy.[7]
An ammonia level more than 200 strongly suggests hepatic encephalopathy.[3]
Other important laboratory findings in hepatic encephalopathy may include:
- Anemia is a predictor of hepatic encephalopathy in some patients with hepatic cirrhosis.[10]
- Liver function tests: patients may have abnormal bilirubin, albumin, AST, ALT, AST/ALT, INR due to underlying hepatic disease.[11]
- Hypercreatinemia may be present in patients with end-stage liver disease.[12]
References
References
- ↑ Kratz A, Lewandrowski KB (1998). “Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Normal reference laboratory values”. N Engl J Med. 339 (15): 1063. doi:10.1056/NEJM199810083391508.
- ↑ Sheikh MF, Mookerjee RP, Agarwal B, Acharya SK, Jalan R (2019). “Prognostic Role of Ammonia in Cirrhotic Patients”. Hepatology. doi:10.1002/hep.30534. PMID 30703853.
- ↑ 3.0 3.1 3.2 3.3 Ong JP, Aggarwal A, Krieger D; et al. (2003). “Correlation between ammonia levels and the severity of hepatic encephalopathy”. The American journal of medicine. 114 (3): 188–93. PMID 12637132. Unknown parameter
|month=ignored (help) - ↑ Stahl J (1963). “Studies of the blood ammonia in liver disease. Its diagnostic, prognostic, and therapeutic significance”. Annals of internal medicine. 58: 1–24. PMID 13978712. Unknown parameter
|month=ignored (help) - ↑ Nicolao F, Efrati C, Masini A, Merli M, Attili AF, Riggio O (2003). “Role of determination of partial pressure of ammonia in cirrhotic patients with and without hepatic encephalopathy”. Journal of hepatology. 38 (4): 441–6. PMID 12663235. Unknown parameter
|month=ignored (help) - ↑ Ge PS, Runyon BA (2014). “Serum ammonia level for the evaluation of hepatic encephalopathy”. JAMA. 312 (6): 643–4. doi:10.1001/jama.2014.2398. PMID 25117134.
- ↑ Sharma P, Sharma BC, Sarin SK (2009). “Predictors of nonresponse to lactulose for minimal hepatic encephalopathy in patients with cirrhosis”. Liver Int. 29 (9): 1365–71. doi:10.1111/j.1478-3231.2009.02067.x. PMID 19555401.
- ↑ Yun BC, Kim WR (2009). “Hyponatremia in hepatic encephalopathy: an accomplice or innocent bystander?”. Am J Gastroenterol. 104 (6): 1390–1. doi:10.1038/ajg.2009.287. PMID 19455127.
- ↑ Gaduputi V, Chandrala C, Abbas N, Tariq H, Chilimuri S, Balar B (2014). “Prognostic significance of hypokalemia in hepatic encephalopathy”. Hepatogastroenterology. 61 (133): 1170–4. PMID 25436277.
- ↑ Kalaitzakis E, Josefsson A, Castedal M, Henfridsson P, Bengtsson M, Andersson B; et al. (2013). “Hepatic encephalopathy is related to anemia and fat-free mass depletion in liver transplant candidates with cirrhosis”. Scand J Gastroenterol. 48 (5): 577–84. doi:10.3109/00365521.2013.777468. PMID 23452072.
- ↑ Djiambou-Nganjeu H (2017). “Hepatic Encephalopathy in Liver Cirrhosis”. J Transl Int Med. 5 (1): 64–67. doi:10.1515/jtim-2017-0013. PMC 5490964. PMID 28680841.
- ↑ Hartleb M, Gutkowski K (2012). “Kidneys in chronic liver diseases”. World J Gastroenterol. 18 (24): 3035–49. doi:10.3748/wjg.v18.i24.3035. PMC 3386317. PMID 22791939.
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Mohamadmostafa Jahansouz M.D.[2]
