Oral Keto Analogs of Branched-Chain Amino Acids in Hyperammonemia in Patients with Cirrhosis of the Liver

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Abstract
Previous uncontrolled studies indicated a positive effect of keto analogs of amino acids on plasma ammonia in patients with cirrhosis of the liver and on portalsystemic encephalopathy. In the present double-blind study, the influence of keto analogs of the branched chain amino acids valine, leucine and isoleucine on plasma ammonia and encephalopathy was investigated in 12 patients with cirrhosis of the liver and surgical portal systemic shunts. In addition to the usual therapy with lactulose and protein restriction (40 g protein/day) all patients received 15.24 g keto analogs and placebo orally over 4 wk in a crossover regimen. In contrast to uncontrolled studies, plasma ammonia, which was elevated in all patients before the beginning of the study, was not signficantly changed. In addition, plasma amino acids, EEG, number connection test, clinical state and laboratory tests were not influenced by the therapy with keto analogs.