Impact of intestinal mannitol on hyperammonemia,oxidative stress and severity of hepatic encephalopathy in the ED

Hyperammonemia results from hepatic inability to remove nitrogenous products generated by protein metabolism of intestinal microbiota, which leads to hepatic encephalopathy (HE) in chronic liver disease (CLD). In ammonium neurotoxicity, oxidative stress (OxS) plays a pathogenic role. Our objective was to evaluate if intestinal mannitol is as effective and safe as conventional treatment for diminishing hyperammonemia, OxS, and HE in patients with CLD.

Material and methods

We included 30 patients with HE classified by “Haven Criteria for Hepatic Encephalopathy”. They were randomized into two groups: 1) Mannitol Group (MG) with mannitol 20% administered into the intestine by an enema, 2) conventional group (CG) with lactulose 40?g enema both substances were diluted in 800?mL of double distilled solution every 6?h; all patients received neomycin. We evaluated ammonia concentration, plasma oxidative stress, HE severity, intestinal discomfort and adverse effects.

Results

Hyperammonemia (171?±?104 vs 79?±?49?μmol ammonia/L, p?

Conclusions

Intestinal mannitol is as effective and safe as conventional treatment for reducing hyperammonemia, oxidative stress, and hepatic encephalopathy of CLD patients in the emergency room. Likewise, mannitol is better tolerated than conventional treatment.