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Free Amino Acids in Plasma and Muscle in Fulminant Hepatic Coma During an Extracorporeal Liver Perfusion
Author(s) -
Roth E.,
Muhlbacher F.,
Rauhs R.,
Huk I.,
Soderland K.,
Funovics J.
Publication year - 1982
Publication title -
journal of parenteral and enteral nutrition
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.935
H-Index - 98
eISSN - 1941-2444
pISSN - 0148-6071
DOI - 10.1177/0148607182006003240
Subject(s) - glutamine , extracorporeal , fulminant hepatic failure , perfusion , baboon , hepatic encephalopathy , medicine , amino acid , endocrinology , chemistry , biochemistry , cirrhosis , liver transplantation , transplantation
A 21‐year‐old female patient suffering from fulminant hepatic failure was treated with extracorporeal normothermic baboon's liver perfusion for 60 hours. The amino acids (AA) uptake of the extracorporeal organ and the ratio of plasma and muscle AA at the end of the perfusion were measured. The AA uptake of the extracorporeal liver was 414 millimoles per 60 hours and even greater during hemodialysis treatment. In spite of this AA uptake, the plasma AA pattern was not normalized. At the end of the perfusion, the free AA concentration in muscle tissue was 86.25 millimoles per liter of intracellular water, an increase of 62% compared to healthy volunteers. In the patient, the ratio of glutamine to glutamine in muscle tissue was 20 to 1 compared to 5 to 1 in normals. It is concluded that (1) the extracorporeal baboon liver cannot extract the quantities of AA released by endogenous protein catabolism in hepatic failure, and (2) the muscular ammonia detoxification system gets overloaded as indicated by the increase ratio of glutamine to glutamate.