الفهرس 
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Abstract
Background: Hepatic encephalopathy (HE) is a complication of impaired liver function and is manifested as neuropsychiatric signs and symptoms associated with acute or chronic liver disease in the absence of other neurological disorders. L-ornithine-L-aspartate (LOLA) is not frequently used for treatment of HE as there are still some reservations about its benefits. Aim of the work: To assess the effectiveness of LOLA either alone in high dose or combined with lactulose in regular dose versus lactulose alone in the management of advanced hepatic encephalopathy and their relation to the arterial blood ammonia level. Methods: Interventional randomized double blind clinical trial on sixty cirrhotic patients with hyperammonemia and overt hepatic encephalopathy grade III and IV according to West Haven criteria (WHC). Detailed history, clinical examination and investigations were done in addition to measurement of arterial blood ammonia level at admission, 24, 48 and 72 hours from admission. Patients were randomized to one of three treatment groups, group A (20 patients) received Lactulose alone (400 g/day given as retention enema), group B (20 patients) received high dose LOLA alone (40 g/day infused intravenously) and group C (20 patients) received Lactulose (400 g/day) plus regular dose LOLA (20 g/day); and they were followed up for 4 days of trial. Results: Thirty one patients (51.7%) had grade III HE while 29 patients (48.3%) had grades IV HE on admission. There was significant improvement in Glasgow Coma Scale (GCS) on the 3rd day in group B and C as compared to group A; and on the 4th day in group B as compared to group A and C and group C as compared to group A. There was significant improvement in Clinical Hepatic Encephalopathy Staging Scale (CHESS) on the 4th day in group B as compared to group A and C. There was significant improvement in ammonia level on the 2nd, 3rd and 4th days in group B and C as compared to group A. By the end of the trial full recovery occurred in 50% versus 35% versus 20% in group B, C and A respectively (p < 0.05). A Correlation coefficient showed significant positive correlation between arterial blood ammonia level with CHESS and significant negative correlation with GCS in the 2nd, 3rd, 4th days in all groups. Conclusion: Cirrhotic patients with advanced HE treated with high dose LOLA were associated with significant improvement of HE grade and lowering blood ammonia level than those on the other lines of treatment without appreciable side effects.
Keywords: Hepatic encephalopathy. Liver cirrhosis. Ammonia. L-ornithine-L-aspartate. Lactulose.