| Abstract: | Formation of endogenous toxins through protein metabolism and detoxification through liver are described. In chronic hepatic insufficiency (cirrhosis of the liver), with failure of liver metabolism, levels of endogenous toxins in plasma and tissue, i.e. ammonia, phenol-derivatives and free fatty acids, rise. Plasma levels of ammonia and free fatty acids are both dependent on the Krebs cycle. This interaction and mutual dependance was examined clinically through application of amino acids that lower plasma ammonia level. Di-L(+)ornithin-alpha-ketoglutaric acid was able to lower ammonia levels in patients with liver cirrhosis. The difference between pre- and postinfusion levels of ammonia was significant, this corresponds to the observations of other authors. In addition we found a fall in levels of free fatty acids, triglycerides, and cholesterol. This effect on fatmetabolism was also observed in patients with no evidence of incipient or manifest hepatic insufficiency. The biochemical basis and the clinical implications of these findings are discussed. |
