Oral zinc supplementation in management of hepatic encephalopathy in patients with cirrhosis; A study conducted in developing country.

Abstract

Objective: To evaluate the effectiveness of oral zinc supplementation in cirrhotic patients with hepatic encephalopathy. Study Design: Retrospective Cohort study. Setting: Department of Gastroenterology, Liaquat University of Medical and Health Sciences, Jamshoro. Period: 15^th February 2019 to 15^th August 2019. Material & Methods: Adult patients of either gender suffering from hepatic cirrhosis and presenting with hepatic encephalopathy of any grade were included. Zinc acetate in a dose of 600 mg was given orally to the patients for two weeks duration. Standard lactulose treatment was also given alongside. Blood ammonia measurement was done at baseline and also after 2 weeks of treatment. Performance was assessed by utilization of number connection test (NCT) at week 1 and week 2 weeks post treatment. Results: Study included of 135 patients among which majority 95 (70.4%) of the patients were males. The mean age of the patients were 55.72 + 10.32 years. 40 (26.62%) patients were seen in Child Pugh class A, 65 (48.14%) were seen in Child Pugh class B and 30 (22.2%) were seen in Child Pugh class C. Serum ammonia levels were reduced in 110 (81.48%) patients and improved performance in NCT was seen in 90 (66.66%) patients. There was significant reduction of ammonia levels and significant improvement of NCT test in male patients (p value <0.05) and in Child Pugh class A and B patients (p value <0.05). Conclusion: In addition to standard therapy, inclusion of oral zinc acetate resulted in normalization of blood zinc and ammonia levels with improved performance in NCT and overall hepatic encephalopathy.