A Trial of Ornithine Phenylacetate and the Arc of Ammonia's History in the Management of Overt Hepatic Encephalopathy

A Prospective, Blinded Assessment of Ammonia Testing Demonstrates Low Utility Among Front-Line Clinicians

Although ammonia is essential to the pathophysiology of hepatic encephalopathy (HE), its levels cannot diagnose HE, do not correlate with the grade of HE, and are plagued by technical challenges.¹ Nevertheless, ammonia levels are routinely obtained in the evaluation of hospitalized patients.² We have advocated for quality improvement to limit testing.³ However, data are lacking regarding the reasons for, context, and perceived value of ammonia testing among ordering clinicians. Additional data are needed to optimize a quality improvement intervention aiming to curb overuse.