What are the neurotoxic effects of ammonia in the pathogenesis of hepatic encephalopathy (HE)?

Updated: May 18, 2020
  • Author: David C Wolf, MD, FACP, FACG, AGAF, FAASLD; Chief Editor: BS Anand, MD  more...
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Ammonia has multiple neurotoxic effects. It can alter the transit of amino acids, water, and electrolytes across astrocytes and neurons. It can impair amino acid metabolism and energy utilization in the brain. Ammonia can also inhibit the generation of excitatory and inhibitory postsynaptic potentials. Inflammation (eg, systemic, neuroinflammation, endotoxemia) in conjunction with ammonia also appears to play a role in hepatic encephalopathy in patients with cirrhosis, which may indicate that different types of anti-inflammatory therapy be a potential therapeutic approach. [2]

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