The Role of Hepatic Dysfunction Manifested by Hyperammonemia in Patients with Severe Thermal Trauma: Clinical Experience

Introduction. In patients with thermal injury, changes in microcirculation and liver dysfunction lead to impaired detoxification of ammonia, resulting in its accumulation in the body. This develops hyperammonemia, which exacerbates the phenomena of encephalopathy. To date, questions remain regarding the application of hypoammonemic therapy in burn patients and its impact on disease outcomes.

Aim: To assess the severity of hepatic encephalopathy, the level of ammonia in capillary blood, and its reduction against the backdrop of therapy in patients with thermal injury.

Materials and methods. The study selectively included a group of 29 patients with severe burn injury (IF more than 145 units) who were treated in the intensive care unit, and a group with mild burn injury (IF no more than 90 units) of 15 patients who were in the hospital ward. The severity of hepatic encephalopathy was determined using the West Haven scale. The level of ammonia in the serum was investigated by microdiffusion method using the portable express analyzer PocketChemTM BA PA-4140. For the correction of hyperammonemia, ornithine was intravenously administered via an infusion pump at a dose of 80 g/day for 10 days. All statistical calculations were performed using the software SPSS v27 (Statistical Package for the Social Sciences).

Results. According to the Frank index, patients with burn injury were divided into 3 subgroups (1-3), the lesion depth ranged from 31 units to 91 units or more. High levels of ammonia in the blood were recorded in all three subgroups, and with a Franck index of 91 units. and higher than 285 mmol/l in more than half of the patients. There was a direct relationship between the Franck index and the level of ammonia in patients with burn injury (p=0.01). The higher the Franc Index, the higher the level of ammonia in the blood plasma. This trend can be traced both before the start of treatment (rs1=0.971, rs2=0.996) and after the start of treatment (rs1=0.898, rs2=0.948) in both groups of patients. On the 2-3 day of combined treatment with the inclusion of ornithine, a decrease in ammonia in the blood by 20-30 % of the baseline level was noted in all study groups (p <0.001). The level of ammonia after treatment decreased significantly in all 44 patients (p <0.001).

Conclusions. Hepatic dysfunction is one of the manifestations of the systemic response to thermal injury. Therefore, disruption of ammonia utilization processes can have an adverse effect on the overall clinical picture. The presence of liver dysfunction, high levels of ammonia and, as a result, the development of hepatic encephalopathy aggravate the course of burn disease, which significantly complicates the provision of care to this category of patients.

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