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have shown that elevated levels of serum ammonia and myostatin contribute to sarcopenia in cirrhosis.21 And so a vicious circle is formed when a cirrhotic patient develops sarcopenia, given that there is a decrease in the elimination of ammonia in sarcopenic patients, which in turn, leads to a higher risk for developing hyperammonemia and HE.22 The detoxification of ammonia through the administration of L-ornithine L-aspartate (LOLA) in a murine model of sarcopenia and steatohepatitis significantly improved mean body mass, hand grip strength, and mean diameter of muscle fiber, in the group supplemented with LOLA vs

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H., Chu, T

Bypass of first-pass liver metabolism