Ndraha Suzanna, Simadibrata Marcellus
Department of Internal Medicine, Faculty of Medicine, University of Indonesia - Dr. Cipto Mangunkusumo Hospital, Jl. Diponegoro no. 71, Jakarta Pusat 10430, Indonesia.
Acta Med Indones. 2010 Jul;42(3):158-61.
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-L-aspartate (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.
蛋白质摄入过多可导致肝性脑病（HE）。在肝性脑病中限制蛋白质摄入正引发争议，因为这可能会加重营养不良。本文报告了一例营养不良性肝性脑病的病例，该病例采用L-鸟氨酸-L-天冬氨酸（LOLA）治疗，并根据营养状况给予适当饮食。一名62岁男性因入院前6小时意识减退为主诉前来就诊。他被诊断为肝硬化6年。入院前几天他摄入了高蛋白饮食。体格检查显示营养不良和昏迷。通过低临界闪烁频率试验（CFF）和高血氨水平确诊为肝性脑病。给予他适当饮食和LOLA以降低血氨水平并改善CFF。治疗期间，意识恢复正常，CFF升高，血氨水平降低。在该病例中，肝性脑病采用LOLA治疗且未限制蛋白质摄入。在这种情况下，肝性脑病的改善可能是由于LOLA治疗有助于降低血浆氨水平。已安全地给予该II期肝性脑病患者充足的饮食，即35 - 40千卡/千克体重/天，蛋白质摄入量为1.5克/千克体重/天。LOLA似乎能有效降低氨水平并改善脑病。
