Which of the following statements is/are true? A modified amino acid solution with increased equimolar branched-chain amino acids and decreased aromatic amino acids has been proposed for patients with hepatic insufficiency.
A. This formulation is proposed for the use of patients with fulminant hepatitis B. Nitrogen balance is achieved in such patients with amounts of 40 gm. of amino acids per 24 hours. C. The use of 80 to 100 gm. of such solutions is associated with hepatic encephalopathy D. In some studies of surgical patients, improvements in mortality have been reported.
In some studies of surgical patients, improvements in mortality have been reported.-the use of modified amino acid solutions is based on the false neurotransmitter hypothesis of the cause of hepatic coma. according to this hypothesis, the imbalance between aromatic and branched-chain amino acids in the plasma results in abnormally high levels of the toxic aromatic amino acids in the brain, thus provoking hepatic encephalopathy. the use of modified amino acid mixtures, with glucose as the calorie base, has been associated in a number of studies with improvement in encephalopathy. meta-analysis has concluded that the use of such solutions is indicated as therapy for hepatic encephalopathy but has been proposed only for hepatic encephalopathy complicating acute exacerbation of chronic liver disease. although there are a few anecdotal reports of beneficial effects on hepatic encephalopathy of acute fulminant hepatitis, the use of such a solution has not been advocated, but such a modified solution is tolerated better than standard amino acid mixtures in patients requiring tpn. in some studies, particularly in complicated surgical cases, the use of a highbranched-chain, lowaromatic amino acid solution has been associated with lower mortality. these statements are true only for studies in which the modified solutions are given with hypertonic glucose as a calorie base. studies in which lipid was the principal calorie source have not revealed such improvements in mortality. in recent studies, giving an aromatic amino aciddeficient, branched-chain amino acidenriched solution to patients about to undergo resection of the liver has proved particularly efficacious in a group of patients with cirrhosis, decreasing morbidity and showing a trend toward decreased mortality.