The impairment of transsulphuration during methionine degradation in hepatic failure can be counteracted by treatment with S-adenosylmethionine. Regarding the pathogenesis of hepatic encephalopathy, no convincing evidence exists for tryptophan, glutamine or glutamate being involved. Portal-systemic shunting-induced hyperammonaemia may reduce plasma branched-chain amino acids. The glucose effect on urea synthesis does not exist in cirrhosis.
Department of Pathophysiology, Medical Clinic I Mannheim, University of Heidelberg, Germany
Correspondence to Professor Dr Eggert Holm, Department of Pathophysiology, Medical Clinic I, Theodor Kutzer Ufer, D-68167 Mannheim, Germany Tel: +49 621 3832643; fax: +49 621 3832191; e-mail: firstname.lastname@example.org