Effect of hyperammonemia on insulin-mediated glucose uptake in rats

Hepatogenous diabetes: Knowledge, evidence, and skepticism

The diabetogenic potential of liver cirrhosis (LC) has been known for a long time, and the name "hepatogenous diabetes" (HD) was coined in 1906 to define the condition. Diabetes mellitus (DM) that develops as a consequence of LC is referred to as HD. In patients with LC, the prevalence rates of HD have been reported to vary from 21% to 57%. The pathophysiological basis of HD seems to involve insulin resistance (IR) and pancreatic β-cell dysfunction. The neurohormonal changes, endotoxemia, and chronic inflammation of LC initially create IR; however, the toxic effects eventually lead to β-cell dysfunction, which marks the transition from impaired glucose tolerance to HD. In addition, a number of factors, including sarcopenia, sarcopenic obesity, gut dysbiosis, and hyperammonemia, have recently been linked to impaired glucose metabolism in LC. DM is associated with complications and poor outcomes in patients with LC, although the individual impact of each type 2 DM and HD is unknown due to a lack of categorization of diabetes in most published research. In fact, there is much skepticism within scientific organizations over the recognition of HD as a separate disease and a consequence of LC. Currently, T2DM and HD are being treated in a similar manner although no standardized guidelines are available. The different pathophysiological basis of HD may have an impact on treatment options. This review article discusses the existence of HD as a distinct entity with high prevalence rates, a strong pathophysiological basis, clinical and therapeutic implications, as well as widespread skepticism and knowledge gaps.

Hyperammonemia in review: pathophysiology, diagnosis, and treatment

Ammonia is an important source of nitrogen and is required for amino acid synthesis. It is also necessary for normal acid-base balance. When present in high concentrations, ammonia is toxic. Endogenous ammonia intoxication can occur when there is impaired capacity of the body to excrete nitrogenous waste, as seen with congenital enzymatic deficiencies. A variety of environmental causes and medications may also lead to ammonia toxicity. Hyperammonemia refers to a clinical condition associated with elevated ammonia levels manifested by a variety of symptoms and signs, including significant central nervous system (CNS) abnormalities. Appropriate and timely management requires a solid understanding of the fundamental pathophysiology, differential diagnosis, and treatment approaches available. The following review discusses the etiology, pathogenesis, differential diagnosis, and treatment of hyperammonemia.

Ammonia: its effects on biological systems, metabolic hormones, and reproduction

The physical, chemical properties of ammonia, its sources and detoxification, its effects in biological systems, its influence upon insulin action and glucose metabolism, and its possible effects on reproduction are discussed. Present chemical methods do not distinguish nonionic from ionic forms. At physiological pH, nonionic ammonia concentrations remain low but are primarily responsible for toxic effects. Thus, biologically significant changes of ammonia concentrations may not be revealed by determinations of ammonia in blood plasma. For these and other reasons the subacute toxicity of ammonia often is unrecognized, and its effects on intermediary metabolism and the hormonal milieu in normal and disease states remain poorly understood. Effects of ammonia may be stimulatory at low concentrations and inhibitory as concentrations rise or exposure is extended. Extensive experiments in eight ureotelic species, including man, show that urinary excretion of orotic acid becomes significantly elevated when the quantity of ammonia presented to the liver exceeds the capacity for normal detoxification. Present evidence with arginine and other intermediates of the urea cycle suggest that these substances influence glucose metabolism and insulin action. Recent studies of dairy cattle provide speculative evidence that high protein feeding or forms of protein that lead to elevated ammonia concentrations in tissue decrease conception rates and increase the calving to conception interval of dairy cows. Limited data concerning luteinizing hormone concentrations and steroid hormone metabolism are insufficient to establish whether differences in reproductive performance are due to changes of hormonal physiology, intrauterine environment, or metabolism.