EFFECT OF GLUCOSE ORAL-ADMINISTRATION ON HYPERAMMONEMIA IN CIRRHOTICS

In order to investigate the controverted effect of glucose on hyperammonemia the diet of eight advanced cirrhotics was supplemented hourly, between 9 a.m. and 5 p.m., with 20 g of glucose orally. Plasma insulin and arterial and median cubital venous ammonia levels were measured hourly and the results were compared to those of a control test performed in the same patients without glucose supplementation. In the control test the lunch (protein meal) induced an identical rise in arterial and venous ammonia levels (+40 ± 3 and +36 ± 5 μg/100 ml, respectively). With glucose supplementation plasma insulin rose significantly and the arterial ammonia increase produced by lunch (+42 ± 3 μg/100 ml) did not differ from that observed in the control test; but the rise in venous ammonemia was lower (+12 ± 4 μg/100 ml; p < 0.01) with a significant increase in arterio-venous ammonia difference. These results suggest that oral glucose administration increases the peripheral muscular ammonia uptake through a mechanism which remains to be elucidated but which is inefficient for arterial hyperammonemia. © 1978.