Source: Neurocase  |  Posted 9 years ago

A consistent nitrogen sparing mechanism has been found to be produced by misoprostol in patients with cirrhosis, and the effects are not mediated by hormone levels.

The effects found in the study of long-term oral misoprostol administration on hepatic amino acid-nitrogen metabolism in patients with cirrhosis may prove to be beneficial in clinical hepatology, declares Dr. Giampaolo Bianchi and colleagues at the University of Bologna, Bologna, Italy. They say controlled trials are now needed to assess the effects found in their study.

The clinicians point out that the acute infusion of a prostaglandin of E series 1 (PGE1) analogue produces nitrogen sparing among patients with cirrhosis. In order to test the effects of long-term oral PGE1 on hepatic and whole-body nitrogen metabolism, they enrolled 10 patients with advanced cirrhosis.

The patients were studied in paired experiments before and 30-50 days after they had received oral misoprostol therapy.

Alpha-amino-nitrogen levels and urea-nitrogen synthesis rate were measured in the post-absorption state, and in response to continuous alanine infusion at 2 mmol/kg per hour for 4.5 hours. The data obtained were used to compute the functional hepatic nitrogen clearance.

Dr. Bianchi and colleagues found that misoprostol reduced urea-nitrogen synthesis rate, both during fasting and in response to alanine, and this resulted in a positive nitrogen exchange. There was a slight increase in functional hepatic nitrogen clearance, with the indication of a reduced urea synthesis rate at any alpha-amino-N concentration.

There was no accumulation in plasma of either amino acid- and ammonia-N. In addition, the clinicians did not observe any systematic effects on insulin and glucagon.