Advanced liver disease, such as cirrhosis, can cause disability and death from hepatic encephalopathy (HE.) This is characterized by abnormal brain function, from memory loss to coma. Current treatments are hampered by ineffectiveness and side effects.
Ammonia from liver dysfunction can pass easily through the blood-brain barrier to cause symptoms of the nervous system. L-acyl-carnitine (acetyl-l-carnitine) was proposed as a treatment for HE on a theoretical, scientific basis. Carnitine is a cofactor for the oxidation of fats in mitochondria and promotes the production of acetylcholine.
The mechanism by which carnitine works is unknown. There is some suggestion that carnitine reduces ammonia levels, improves psychological testing and improves electroencephalogram (EEG) brain wave tests in HE patients.
This study is about the medical articles published previously testing the use of carnitine in HE. Three studies were included which met the author’s requirements. Two studies demonstrated the superiority of 4 gms. carnitine over placebo in the treatment of HE. Blood ammonium levels and a ‘number connection’ psychological test were included in the patient’s evaluation. Another study showed improved serum ammonia levels and blood tests of blood urea nitrogen (BUN) and a slight worsening of a coma scale.
More studies are needed. Carnitine is beneficial in mild HE, with low toxicity and low cost. There is some doubt about the use of carnitine in severe HE. Although the patients showed improvement on testing, coma scores were a little worse after treatment.
CONCLUSION: Carnitine is a safe effective therapy in mild hepatic encephalopathy. The benefit is not so clear in severe hepatic encephalopathy with coma. Acyl-l-carnitine is promising.
NOTE: Acetyl-l-carnitine is believed to be the most active form of carnitine in the body. Read more about hepatic encephalopathy.T
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