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By your follow-up appointment, you're left with vague impressions rather than facts about when symptoms began, how often they occur, or whether they're improving

Socha, P., Horvath, A., Vajro, P., Dziechciarz, P., Dhawan, A., and Szajewska, H

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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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Document these alongside weight and metabolic changes to identify correlations between metabolic improvement and autoimmune disease activity