title: Regional variations in the concentrations of ketone bodies in cirrhosis and hepatic encephalopathy: a study in patients with TIPSS.
abstract: BACKGROUND
  Little is known about the metabolism of acetoacetate and β-hydroxybutyrate in patients with cirrhosis and encephalopathy.
  
  
  OBJECTIVE
  We investigated the fate of ketone bodies in these conditions.
  
  
  METHODS
  We studied 18 cirrhotic patients with encephalopathy and 17 cirrhotics without. At the time of insertion of a transjugular intrahepatic portosystemic stent shunt (TIPSS) or at the time of portographical assessment of the shunt's patency, we collected blood from the internal jugular, the right atrium, the inferior vena cava, the hepatic, the portal, the splenic veins and the radial artery. We used nuclear magnetic resonance spectroscopy to measure the concentrations of acetoacetate and β-hydroxybutyrate.
  
  
  RESULTS
  There was no difference in the total ketone body concentrations between the two groups. The mitochondrial redox potential was significantly higher in the encephalopathics (142/54=2.63 vs 52/83=0.62) (P<0.01). β-hydroxybutyrate was significantly lower in the portal vein of encephalopathics (52 ± 4 vs 28 ± 3) (P<0.02) and in the splenic vein (48 ± 6 vs 32 ± 5) (P<0.04). Acetoacetate was significantly higher in encephalopathics in the internal jugular vein (134 ± 12 vs 92 ± 16) (P<0.03), the right atrium (112 ± 18 vs 68 ± 11) (P<0.03), the hepatic vein (162 ± 25 vs 115 ± 19) (P<0.05), the portal vein (133 ± 20 vs 81 ± 14) (P<0.02) and the splenic vein (167 ± 24 vs 122 ± 21) (P<0.04). All measurements are expressed in μmols/L.
  
  
  CONCLUSIONS
  There are significant variations in the regional concentrations of the ketone bodies in encephalopathy.
authors: Department of Hepatology, University of Edinburgh, Edinburgh, UK. kostasophia@yahoo.com
authors: Konstantinos J
authors: KJ
authors: Dabos
authors: Benjamin A
authors: BA
authors: Haughton
authors: Benjamin J
authors: BJ
authors: Houghton
authors: Emmanouil
authors: E
authors: Pyleris
authors: Doris N
authors: DN
authors: Redhead
authors: Peter C
authors: PC
authors: Hayes
authors: Ian H
authors: IH
authors: Salder
authors: John N
authors: JN
authors: Plevris
mesh_terms: D020155:3-Hydroxybutyric Acid / Q000097:blood*; D000090:Acetoacetates / Q000097:blood*; D000328:Adult; D000704:Analysis of Variance; D015415:Biomarkers / Q000097:blood; D005260:Female; D006501:Hepatic Encephalopathy / Q000097:blood* / Q000209:etiology; D006801:Humans; D008099:Liver / Q000378:metabolism*; D008103:Liver Cirrhosis / Q000097:blood / Q000150:complications / Q000601:surgery*; D009682:Magnetic Resonance Spectroscopy; D008297:Male; D008875:Middle Aged; D019168:Portasystemic Shunt, Transjugular Intrahepatic; D012606:Scotland; D016896:Treatment Outcome
chemical_list: D000090:Acetoacetates; D015415:Biomarkers; C016635:acetoacetic acid; D020155:3-Hydroxybutyric Acid