Normal Protein Diet and L-Ornithine-L-Aspartate For Hepatic Encephalopathy
Normal Protein Diet and L-Ornithine-L-Aspartate For Hepatic Encephalopathy
Normal Protein Diet and L-Ornithine-L-Aspartate For Hepatic Encephalopathy
Department of Internal Medicine, Faculty of Medicine, University of Indonesia - Dr. Cipto Mangunkusumo Hospital.
Jl. Diponegoro no. 71, Jakarta Pusat 10430, Indonesia.
Correspondence mail to: susan_ndraha@yahoo.co.id
ABSTRACT
Excessive protein intake can cause hepatic
encephalopathy (HE). Restricting protein in HE is
becoming a controversy, because it can worsen
malnutrition. This article reports the case of an under
nourishment HE which is treated with L-ornithine-Laspartate (LOLA) and given appropriate diet according
to the nutrition status.
A 62-year-old man came with chief complaint of
having reduced consciousness since 6 hours before admission. He had been diagnosed as liver cirrhosis for 6 years.
Several days prior to admission he took high protein diet.
Physical examination revealed under nutrition and
unconsciousness. Hepatic encephalopathy was confirmed
with low critical flicker test (CFF), and high blood
ammonia level. He was treated with adequate diet and
LOLA to decrease blood ammonia and improve the CFF.
During the treatment, consciousness improved to normal,
CFF increased and ammonia level decreased.
In this case, the HE was treated with LOLA without
protein restriction. The HE improvement, in this
circumstance may be caused of LOLA treatment that helps
decrease the plasma ammonia level.
Adequate diet, 35-40 kcal/kgBW/d and protein intake
1.5 g/kgBW/d, has been administered safely to this
patient with stage II hepatic encephalopathy. LOLA seemed
to be effectively reduced ammonia level and improved the
encephalopathy.
Key words: liver cirrhosis, hepatic encephalopathy,
L-ornithine L-aspartate, critical flicker test, blood
ammonia level.
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INTRODUCTION
Suzanna Ndraha
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