Lack of brain edema in acute on chronic liver failure results from compensatory mechanisms in skletetal muscle and brain
Butterworth R, Rose C, Zwingmann C, Leibfritz D
In acute Hepatic Encephalopathy (HE), the major cause of death is brain edema. Brain edema is rarely encountered in acute-on-chronic liver failure (ACLF). We investigated whether ALF and ACLF result in differences in relation to the onset of brain edema, blood ammonia and cerebral metabolism using ex vivo NMR. ALF caused significant changes compared to ACLF: a) increased brain water, 2. increased arterial ammonia concentrations, 3. decreased brain glutamine synthesis through pyruvate carboxylase, 4. increased brain lactate synthesis, and 5. decreased brain aspartate synthesis. Our observations suggest that impaired brain energy metabolism and ammonia play a key role in ALF.