Intravenous Branched Chain Amino Acids for Hepatic Encephalopathy in ACLF
Intravenous Branched Chain Amino Acids for Hepatic Encephalopathy in ACLF
This study analyses the effect of intravenous branched chain amino acids (BCAA) on overt HE
 in patients with ACLF. The investigators plan to study the efficacy of combining intravenous
 BCAA with lactulose versus lactulose alone in the medical management of overt HE in patients
 with ACLF and its impact on overall survival and improvement in grade of HE.
Acute on chronic liver failure (ACLF) is a distinct clinical entity in the spectrum of
 chronic liver disease associated with high short term mortality. Hepatic encephalopathy (HE)
 is commonly seen in patients with ACLF and its treatment mainly involves non-absorbable
 disaccharides (lactulose/lactitol).Treatment of HE in ACLF is based on extrapolation of data
 available from cirrhotic patients. No studies have compared different treatment options for
 HE in patients with ACLF.
Inclusion Criteria:

 1. Age 18-75 years

 2. Either gender

 3. Patients with ACLF (CANONIC definition) of any aetiology with HE ≥grade 2 as per
 West-Haven Criteria

 Exclusion Criteria:

 1. Those who do not consent to participate in the study

 2. Patients with structural brain lesions or stroke

 3. Inability to obtain informed consent from patient or relatives

 4. Severe preexisting cardiopulmonary disease

 5. Renal dysfunction (S. Creatinine ≥ 2mg/dL)

 6. Pregnancy/Lactation

 7. Post liver transplant patients

 8. HIV infection

 9. Patients who are on psychoactive drugs, like sedatives or antidepressants

 10. Patients who are too sick to carry out the protocol