Amino acid alterations and encephalopathy in the sepsis syndrome

C. L. Sprung, F. B. Cerra, H. R. Freund, R. M.H. Schein, F. N. Konstantinides, E. H. Marcial, M. Pena

Research output: Contribution to journalArticle

73 Scopus citations


Objective: To evaluate the role of amino acid profiles in septic encephalopathy. Design: Retrospective analysis. Setting: Medical wards and medical ICU of a university hospital. Patients: Patients with infections and normal mental status were compared with patients with septic shock and altered sensorium. Interventions: Plasma amino acid levels and Acute Physiology and Chronic Health Evaluation (APACHE II) scores were determined. Measurements and Main Results: Patients with septic shock and altered sensorium had higher circulating concentrations of ammonia (425 ± 55 vs. 127 ± 7 mmol/L) and the aromatic amino acids phenylalanine (122 ± 19 vs. 74 ± 3 mmol/L) and tryptophan (97 ± 7 vs. 32 ± 13 mmol/L), and lower levels of the branch-chain amino acid isoleucine (48 ± 7 vs. 68 ± 5 mmol/L) than patients with infections and normal sensorium (p < .05). Aromatic amino acid levels correlated with APACHE II scores (r2 = .4, p < .001) and mortality. APACHE II scores were higher in the septic shock patients (30 ± 2 vs. 8 ± 1, p < .001), and these patients had a higher mortality rate (71% vs. 12%, p < .01). Patients with septic shock who died had higher levels of ammonia (524 ± 58 vs. 227 ± 40 mmol/L, p < .05) and sulfur-containing amino acids (172 ± 31 vs. 61 ± 7 mmol/L, p < .05) than patients who survived. Conclusions: Plasma amino acid profiles appear to be important in septic encephalopathy and the severity of septic disease.

Original languageEnglish (US)
Pages (from-to)753-757
Number of pages5
JournalCritical care medicine
Issue number6
StatePublished - Jan 1 1991
Externally publishedYes


  • Amino acids
  • Ammonia
  • Critical care
  • Encephalopathy
  • Infection
  • Liver function tests
  • Mental status
  • Metabolism
  • Nutrition
  • Septic
  • Shock

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

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    Sprung, C. L., Cerra, F. B., Freund, H. R., Schein, R. M. H., Konstantinides, F. N., Marcial, E. H., & Pena, M. (1991). Amino acid alterations and encephalopathy in the sepsis syndrome. Critical care medicine, 19(6), 753-757.