Efficacy of L-Ornithine L-Aspartate in Acute Hepatic Encephalopathy.
Efficacy of L-Ornithine L-Aspartate in Acute Hepatic Encephalopathy.
Hepatic encephalopathy is caused by the effects on the brain of substances that under normal
 circumstances are efficiently metabolized in the liver. The hyperammonemia is the main factor
 responsible for the development of hepatic encephalopathy. In patients with cirrhosis, the
 reduction in hepatocellular function and generation of portosystemic shunts contribute to
 increase serum ammonium. The current therapeutic approaches, are aimed at reducing blood
 ammonium levels.

 Administration of the non-absorbable disaccharides, have become standard treatment of hepatic
 encephalopathy.There are no adequate clinical trials comparing the efficacy of
 L-Ornithine-L-Aspartate (LOLA) infusion against lactose enemas in the treatment of acute
 hepatic encephalopathy.
The main impact of hepatic encephalopathy in patients with cirrhosis is not related to costs,
 but its association with decreased survival and quality of life and should therefore clearly
 established the effectiveness of therapeutic interventions used in this disorder.

 At the end of the nineteenth century to the ammonium was identified as the main agent
 responsible for the development of the syndrome of hepatic encephalopathy. Since then,
 reduced nitrogen compounds from the intestine are considered the main therapeutic measure. On
 this conceptual base, nonabsorbable disaccharides are the first line therapy in hepatic
 encephalopathy.

 Current knowledge indicates that other organs such as muscle, brain and kidney are involved
 in the generation of ammonium, which has set the pace for the development of new treatments,
 able to act systemically in metabolism and elimination of ammonia . L-ornithine L-aspartate
 (LOLA) lowers ammonium concentrations in animal and humans models with hyperammonemia. There
 are no adequate clinical trials comparing the efficacy of LOLA infusion against lactose
 enemas in the treatment of acute hepatic encephalopathy.
Inclusion Criteria:

 -  Patients with cirrhosis of any etiology, diagnosed by ultrasound,clinical and / or
 histologic criteria

 -  Patients over 18 years and under 75

 -  Patients with hepatic encephalopathy grade 3-4 according to the criteria of West Haven

 -  Patients with hyperammonemia >35 µmol/l

 Exclusion Criteria:

 -  Evidence of other neurological or psychiatric abnormality

 -  Renal failure (serum creatinine greater than 3 mg / dL)

 -  Use of drugs affecting the central nervous system

 -  Withdrawal Syndrome