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Refining the Ammonia Hypothesis

Overview of attention for article published in Mayo Clinic Proceedings, May 2015
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About this Attention Score

  • In the top 5% of all research outputs scored by Altmetric
  • High Attention Score compared to outputs of the same age (97th percentile)
  • Good Attention Score compared to outputs of the same age and source (77th percentile)

Mentioned by

118 tweeters
2 Facebook pages


70 Dimensions

Readers on

113 Mendeley
Refining the Ammonia Hypothesis
Published in
Mayo Clinic Proceedings, May 2015
DOI 10.1016/j.mayocp.2015.03.003
Pubmed ID

Elliot B. Tapper, Z. Gordon Jiang, Vilas R. Patwardhan


Hepatic encephalopathy (HE) is one of the most important complications of cirrhosis and portal hypertension. Although the etiology is incompletely understood, it has been linked to ammonia directly and indirectly. Our goal is to review for the clinician the mechanisms behind hyperammonemia and the pathogenesis of HE to explain the rationale for its therapy. We reviewed articles collected through a search of MEDLINE/PubMed, Cochrane Database of Systematic Reviews, and Google Scholar between October 1, 1948, and December 8, 2014, and by a manual search of citations within retrieved articles. Search terms included hepatic encephalopathy, ammonia hypothesis, brain and ammonia, liver failure and ammonia, acute-on-chronic liver failure and ammonia, cirrhosis and ammonia, portosytemic shunt, ammonia and lactulose, rifaximin, zinc, and nutrition. Ammonia homeostatsis is a multiorgan process involving the liver, brain, kidneys, and muscle as well as the gastrointestinal tract. Indeed, hyperammonemia may be the first clue to poor functional reserves, malnutrition, and impending multiorgan dysfunction. Furthermore, the neuropathology of ammonia is critically linked to states of systemic inflammation and endotoxemia. Given the complex interplay among ammonia, inflammation, and other factors, ammonia levels have questionable utility in the staging of HE. The use of nonabsorbable disaccharides, antibiotics, and probiotics reduces gut ammoniagenesis and, in the case of antibiotics and probiotics, systemic inflammation. Nutritional support preserves urea cycle function and prevents wasting of skeletal muscle, a significant site of ammonia metabolism. Correction of hypokalemia, hypovolemia, and acidosis further assists in the reduction of ammonia production in the kidney. Finally, early and aggressive treatment of infection, avoidance of sedatives, and modification of portosystemic shunts are also helpful in reducing the neurocognitive effects of hyperammonemia. Refining the ammonia hypothesis to account for these other factors instructs a solid foundation for the effective treatment and prevention of hepatic encephalopathy.

Twitter Demographics

The data shown below were collected from the profiles of 118 tweeters who shared this research output. Click here to find out more about how the information was compiled.

Mendeley readers

The data shown below were compiled from readership statistics for 113 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
United States 1 <1%
Italy 1 <1%
Germany 1 <1%
Unknown 110 97%

Demographic breakdown

Readers by professional status Count As %
Student > Bachelor 16 14%
Student > Postgraduate 15 13%
Student > Master 15 13%
Researcher 14 12%
Other 13 12%
Other 27 24%
Unknown 13 12%
Readers by discipline Count As %
Medicine and Dentistry 63 56%
Agricultural and Biological Sciences 5 4%
Nursing and Health Professions 4 4%
Biochemistry, Genetics and Molecular Biology 4 4%
Neuroscience 4 4%
Other 11 10%
Unknown 22 19%

Attention Score in Context

This research output has an Altmetric Attention Score of 78. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 25 May 2020.
All research outputs
of 15,148,084 outputs
Outputs from Mayo Clinic Proceedings
of 3,512 outputs
Outputs of similar age
of 227,831 outputs
Outputs of similar age from Mayo Clinic Proceedings
of 36 outputs
Altmetric has tracked 15,148,084 research outputs across all sources so far. Compared to these this one has done particularly well and is in the 98th percentile: it's in the top 5% of all research outputs ever tracked by Altmetric.
So far Altmetric has tracked 3,512 research outputs from this source. They typically receive a lot more attention than average, with a mean Attention Score of 23.3. This one has done particularly well, scoring higher than 94% of its peers.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 227,831 tracked outputs that were published within six weeks on either side of this one in any source. This one has done particularly well, scoring higher than 97% of its contemporaries.
We're also able to compare this research output to 36 others from the same source and published within six weeks on either side of this one. This one has done well, scoring higher than 77% of its contemporaries.