Comments on: Secondary prevention in cirrhosis http://www.medrants.com/archives/3458 Contemplating medicine and the health care system Sat, 20 Mar 2010 04:42:37 +0000 http://wordpress.org/?v=2.9.2 hourly 1 By: rcentor http://www.medrants.com/archives/3458/comment-page-1#comment-517851 rcentor Mon, 04 Feb 2008 13:25:15 +0000 http://www.medrants.com/index.php/archives/3458#comment-517851 I agree with the above comment. I did not mean to imply that I follow serum ammonia levels, rather that I use it as adjunctive data. Your explanation parallels the explanation that I use. Thanks I agree with the above comment. I did not mean to imply that I follow serum ammonia levels, rather that I use it as adjunctive data. Your explanation parallels the explanation that I use.

Thanks

]]> By: Robert S Lake http://www.medrants.com/archives/3458/comment-page-1#comment-517848 Robert S Lake Mon, 04 Feb 2008 12:47:10 +0000 http://www.medrants.com/index.php/archives/3458#comment-517848 Great post but I have concerns with #3 using "serum ammonia levels as a surrogate for the neurotoxin". I am not aware of any studies that demonstrate that the level of serum ammonia has any relation to the degree of encephalopathy. You really don't need a number as a surrogate marker as you've got a much better marker in the patient. I find it useful to measure the serum ammonia once as a way to rule out/in causes of encephalopathy. Thereafter, I use the clinical manifestations (level of encephalopathy) to guide therapy. After all, I really don't care what the serum ammonia level is: if the patient's condition is improved then the therapy is working, if no improvement, then time to try something else Great post but I have concerns with #3 using “serum ammonia levels as a surrogate for the neurotoxin”.

I am not aware of any studies that demonstrate that the level of serum ammonia has any relation to the degree of encephalopathy.

You really don’t need a number as a surrogate marker as you’ve got a much better marker in the patient.

I find it useful to measure the serum ammonia once as a way to rule out/in causes of encephalopathy.

Thereafter, I use the clinical manifestations (level of encephalopathy) to guide therapy. After all, I really don’t care what the serum ammonia level is: if the patient’s condition is improved then the therapy is working, if no improvement, then time to try something else

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