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Role of Ammonia in Hepatic Encephalopathy Essay

The human liver is truly amazing, however little is ever said about the organ. Most people probably wouldn’t be able to locate their liver if they’re asked to do so. The second largest organ in the body and weighing about 3 pounds, the liver is located right under your rib cage on the right side of your body. It is the only organ that is able to regenerate. While most organs replace damage with scar tissue, the liver has the ability to replace damaged tissues with new cells. The primary function of the liver is to process food that has been consumed into nutrients and filter out any harmful substances that may be the bloodstream.

The liver is responsible for keeping our blood suitable for our bodies. With that understood it saddens me to say that there is an estimated 30 million people living in the U.S. with liver failure. These 30 million people are unable to filter out any harmful toxins that may be flowing in their bloodstream. With time they may began to suffer from Hepatic Encephalopathy. Described as episodes of confusion and altered levels of consciousness Hepatic Encephalopathy is caused by to an accumulation of ammonia in the bloodstream that would usually be filtered out by the liver.

Although Hepatic encephalopathy is completely reversible with treatment there are very few treatments available. Pharmaceutical have saved many lives through experimental studies and treatments. Although very controversial; many people choose to participate in these studies in hopes of increasing their chances to live a normal life despite suffering from an ailment. I chose to do my assignment on a double-blinded study on the use of Glycerol Phenylbutyrate (also known as Ravicti) in patients with Episodic Hepatic Encephalopathy.

The study was completed by Dr. Don Rockey who is the Chief of Medicine at the Medical University of South Carolina. While delivering his oral presentation which he titled “Randomized”, Dr. Rockey mentioned “the study results provide new insight into the importance of ammonia in the pathogenesis of hepatic encephalopathy. Based on its safety profile, Hyperion’s investigational drug, Glycerol Phenylbutyrate shows promise as a novel therapeutic agent.”

The study was conducted with a total of 178 patients selected randomly. 50 of who were on the drug Rifaximin which is a drug also commonly used to prevent episodes of heptatic encephalopany. 29 of the 178 patients were placed on placebo and the remaining 30 patients were placed on the active drug Ravicti. If effective those on the active drug Ravicti should expect to see fewer levels of ammonia in the blood, thus resulting in fewer episodes of heptatic encephalopany. Ho = Patients placed on Ravicti will see no change in ammonia levels in the bloodstream and will continue to have Hepatic Encephalopathy episodes.

H1 = Patients placed on Ravicti will see change in ammonia levels in the bloodstream and will have little to no Hepatic Encephalopathy episodes. The results from the study conclude that among the 119 patients not on Rifaximin showed a highly statistical significant reduction among treated patients with 10% vs. 32% (p= 0.003.) Among the patients in the active part of the study experienced fewer Hepatic Encephalopathy episodes 21% vs. 36% (p=0.021.) Those in the active study also reported ammonia levels to be significantly lower 45.7 vs. 58.15 umol/L, (p=0.0036) (p < 0.01). A concern I noticed while researching this study is the accuracy of the statistical results since this study was two sided this means that curtain results were expected by both the test subjects and its administers. This study was also done on a small population of people, which is a bias in itself since the sample population lacks diversity. Factors like diet, environment and previous medications were not mentioned in the study which also can contribute to hepatic encephalopathy episodes. Another key factor that is important to gaining a reasonable sample through population is a correlation between test subjects. It was never mentioned in the article what type of liver failure the subjects suffer from nor did the article specify the severity of their condition. Works Cited Annes, Shari. “HALT-HE Study Underscores Role of Ammonia in Hepatic Encephalopathy.” MedNews. Micromedex, Nov. 2012. Web. 13 Nov. 2012. .

“A New and Unique Way to Measure Liver Function.” Liver Disease Questions. Liver Association of America, n.d. Web. 13 Nov. 2012. .

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