Splanchnic and leg exchange of amino acids and ammonia in acute liver failure  Jens Otto Clemmesen, Jens Kondrup, Peter Ott  Gastroenterology  Volume 118, Issue 6, Pages 1131-1139 (June 2000) DOI: 10.1016/S0016-5085(00)70366-0 Copyright © 2000 American Gastroenterological Association Terms and Conditions

Fig. 1 All data are from patients with ALF. (A) Relationship between arterial concentration of glutamine and splanchnic exchange rate of ammonia (n = 20). Minus denotes release. (B) Relationship between arterial concentration of glutamine and the sum of splanchnic exchange rates of alanine, citrulline, and proline (n = 20). Minus denotes release. (C) Arterial-hepatic venous concentration (a-hv) differences of urea-nitrogen (urea-N) and ammonia (n = 22). One data point (urea-N, 3400 μmol/L; ammonia, 11 μmol/L) is not shown for visual reasons. (D) Relationship between splanchnic concentration differences of ammonia and alanine (n = 22). One data point (ammonia, −94 μmol/L; alanine, −259 μmol/L) is not shown for visual reasons. Dotted line show line of identity. The slope of the linear correlation line is 0.93 (95% confidence interval, 0.47-1.39). Gastroenterology 2000 118, 1131-1139DOI: (10.1016/S0016-5085(00)70366-0) Copyright © 2000 American Gastroenterological Association Terms and Conditions

Fig. 2 Relationship between arterial concentration of bicarbonate and splanchnic amino acid exchange rate. Minus denotes release. One data point was considered as an outlier (HCO3−, 30 mmol/L; amino acid exchange rate, −2183 μmol/min; see Results). Two patients in whom hepatic blood flow could not be estimated had a negative arterial-hepatic venous amino acid gradient. r2 = 0.28; P = 0.02. Gastroenterology 2000 118, 1131-1139DOI: (10.1016/S0016-5085(00)70366-0) Copyright © 2000 American Gastroenterological Association Terms and Conditions

Fig. 3 Relationship between arterial-femoral venous concentration differences (a-fv) of ammonia and (A) glutamine, (B) alanine, and (C) BCAAs in 7 patients with ALF. The relationship between arterial-femoral venous concentration differences of ammonia and the individual BCAA is not shown but was statistically significant in all cases (valine: r2 = 0.73, P < 0.05; isoleucine: r2 = 0.64, P < 0.05; leucine: r2 = 0.81, P < 0.01). Gastroenterology 2000 118, 1131-1139DOI: (10.1016/S0016-5085(00)70366-0) Copyright © 2000 American Gastroenterological Association Terms and Conditions

Fig. 4 Relationship between galactose elimination capacity (normally >32 μmol · kg−1 · min−1) and splanchnic exchange rate of ammonia. Minus denotes release. r2 = 0.28; P = 0.02. Gastroenterology 2000 118, 1131-1139DOI: (10.1016/S0016-5085(00)70366-0) Copyright © 2000 American Gastroenterological Association Terms and Conditions

Fig. 5 Relationship between arterial-femoral venous (a-fv) and arterial-hepatic venous (a-hv) concentration difference of alanine in 7 patients with ALF. Arterial ammonia concentration (μmol/L) is shown next to each data point. 2, Normal direction of both splanchnic and leg gradient; ▵, reversed direction of both splanchnic and leg gradient. Gastroenterology 2000 118, 1131-1139DOI: (10.1016/S0016-5085(00)70366-0) Copyright © 2000 American Gastroenterological Association Terms and Conditions