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Disease-Specific Amino Acid Infusion (F080) in Hepatic Encephalopathy: A Prospective, Randomized, Double-Blind, Controlled Trial

Departments of Medicine and Surgery, University of Minnesota, Minneapolis, MN, Veterans Administration Medical Center, East Orange, New Jersey, University of Cincinnati Medical Center, Cincinnati, Ohio, Wadsworth Veterans Administration Medical Center, Los Angeles, California, UCLA Medical Center, Veterans Administration Medical Center, Miami, Florida, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, Veterans Administration Medical Center, Little Rock, Arkansas, University of Medicine and Dentistry of New Jersey, Newark, New Jersey

Nae K. Cheung, M.D.

Departments of Medicine and Surgery, University of Minnesota, Minneapolis, MN, Veterans Administration Medical Center, East Orange, New Jersey, University of Cincinnati Medical Center, Cincinnati, Ohio, Wadsworth Veterans Administration Medical Center, Los Angeles, California, UCLA Medical Center, Veterans Administration Medical Center, Miami, Florida, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, Veterans Administration Medical Center, Little Rock, Arkansas, University of Medicine and Dentistry of New Jersey, Newark, New Jersey

Josef E. Fischer, M.D.

Departments of Medicine and Surgery, University of Minnesota, Minneapolis, MN, Veterans Administration Medical Center, East Orange, New Jersey, University of Cincinnati Medical Center, Cincinnati, Ohio, Wadsworth Veterans Administration Medical Center, Los Angeles, California, UCLA Medical Center, Veterans Administration Medical Center, Miami, Florida, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, Veterans Administration Medical Center, Little Rock, Arkansas, University of Medicine and Dentistry of New Jersey, Newark, New Jersey

Neil Kaplowitz, M.D.

Departments of Medicine and Surgery, University of Minnesota, Minneapolis, MN, Veterans Administration Medical Center, East Orange, New Jersey, University of Cincinnati Medical Center, Cincinnati, Ohio, Wadsworth Veterans Administration Medical Center, Los Angeles, California, UCLA Medical Center, Veterans Administration Medical Center, Miami, Florida, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, Veterans Administration Medical Center, Little Rock, Arkansas, University of Medicine and Dentistry of New Jersey, Newark, New Jersey

Eugene R. Schiff, M.D.

Departments of Medicine and Surgery, University of Minnesota, Minneapolis, MN, Veterans Administration Medical Center, East Orange, New Jersey, University of Cincinnati Medical Center, Cincinnati, Ohio, Wadsworth Veterans Administration Medical Center, Los Angeles, California, UCLA Medical Center, Veterans Administration Medical Center, Miami, Florida, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, Veterans Administration Medical Center, Little Rock, Arkansas, University of Medicine and Dentistry of New Jersey, Newark, New Jersey

Jules L. Dienstag, M.D.

Departments of Medicine and Surgery, University of Minnesota, Minneapolis, MN, Veterans Administration Medical Center, East Orange, New Jersey, University of Cincinnati Medical Center, Cincinnati, Ohio, Wadsworth Veterans Administration Medical Center, Los Angeles, California, UCLA Medical Center, Veterans Administration Medical Center, Miami, Florida, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, Veterans Administration Medical Center, Little Rock, Arkansas, University of Medicine and Dentistry of New Jersey, Newark, New Jersey

Robert H. Bower, M.D.

Departments of Medicine and Surgery, University of Minnesota, Minneapolis, MN, Veterans Administration Medical Center, East Orange, New Jersey, University of Cincinnati Medical Center, Cincinnati, Ohio, Wadsworth Veterans Administration Medical Center, Los Angeles, California, UCLA Medical Center, Veterans Administration Medical Center, Miami, Florida, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, Veterans Administration Medical Center, Little Rock, Arkansas, University of Medicine and Dentistry of New Jersey, Newark, New Jersey

Charles D. Mabry, M.D.

Departments of Medicine and Surgery, University of Minnesota, Minneapolis, MN, Veterans Administration Medical Center, East Orange, New Jersey, University of Cincinnati Medical Center, Cincinnati, Ohio, Wadsworth Veterans Administration Medical Center, Los Angeles, California, UCLA Medical Center, Veterans Administration Medical Center, Miami, Florida, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, Veterans Administration Medical Center, Little Rock, Arkansas, University of Medicine and Dentistry of New Jersey, Newark, New Jersey

Carroll M. Leevy, M.D.

Departments of Medicine and Surgery, University of Minnesota, Minneapolis, MN, Veterans Administration Medical Center, East Orange, New Jersey, University of Cincinnati Medical Center, Cincinnati, Ohio, Wadsworth Veterans Administration Medical Center, Los Angeles, California, UCLA Medical Center, Veterans Administration Medical Center, Miami, Florida, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, Veterans Administration Medical Center, Little Rock, Arkansas, University of Medicine and Dentistry of New Jersey, Newark, New Jersey

Thomas Kiernan, M.D.

Departments of Medicine and Surgery, University of Minnesota, Minneapolis, MN, Veterans Administration Medical Center, East Orange, New Jersey, University of Cincinnati Medical Center, Cincinnati, Ohio, Wadsworth Veterans Administration Medical Center, Los Angeles, California, UCLA Medical Center, Veterans Administration Medical Center, Miami, Florida, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, Veterans Administration Medical Center, Little Rock, Arkansas, University of Medicine and Dentistry of New Jersey, Newark, New Jersey

Seventy-five patients with acute hepatic decompensation superimposed on chronic alcoholic cirrhosis were prospectively randomized for a blinded trial of the treatment of hepatic encephalopathy. The control group received 4 g of enteral neomycin daily along with 25% dextrose by a central venous catheter. The experimental group received a placebo resembling neomycin and isocaloric dextrose plus a modified amino acid mixture enriched with branched-chain amino acids to 36% and deficient in aromatic amino acids and methionine. Thirty patients in the F080 group and 29 in the control group completed the trial. The group receiving the modified amino acid mixture demonstrated a statistically significant improvement in encephalopathy as compared to the neomycin group, while maintaining nitrogen equilibrium. Survival and discharge from the hospital were statistically greater in the group treated with the modified amino acid solution and hypertonic dextrose. Treatment of hepatic encephalopathy in the presence of hepatic decompensation with an amino acid solution formulated for its treatment seems to produce faster, more complete recovery with improved capacity for nutritional support. (Journal of Parenteral and Enteral Nutrition 9:288-295, 1985)

Journal of Parenteral and Enteral Nutrition, Vol. 9, No. 3, 288-295 (1985)
DOI: 10.1177/0148607185009003288


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