What is the role of zinc in the treatment of hepatic encephalopathy (HE)?

Updated: Apr 04, 2019
  • Author: David C Wolf, MD, FACP, FACG, AGAF, FAASLD; Chief Editor: BS Anand, MD  more...
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Answer

Answer

Zinc deficiency is common in cirrhosis. Even in patients who are not zinc deficient, zinc administration has the potential to improve hyperammonemia by increasing the activity of ornithine transcarbamylase, an enzyme in the urea cycle. The subsequent increase in ureagenesis results in the loss of ammonia ions.

Zinc sulfate and zinc acetate have been used at a dose of 600 mg orally every day in clinical trials. Hepatic encephalopathy improved in two studies [59] ; there was no improvement in mental function in two other studies. [60]

Meena et al evaluated the correlation between low serum zinc levels in 75 patients with decompensated chronic liver disease (DCLD) and various stages of hepatic encephalopathy. There was a statistically significant association between low serum zinc level and grade of HE (P = 0.001) or class of liver cirrhosis (P = 0.001). Additional studies are needed to establish the role of correcting hypozincemia to prevent worsening of cirrhosis and development of encephalopathy. [61]


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