A gas chromatographic--mass spectrometric study of profiles of volatile metabolites in hepatic encephalopathy.

Volatile organic substances present in blood plasma and cerebrospinal fluids of certain control groups of human subjects and cirrhotic patients some of whom were suffering from hepatic encephalopathy were quantitatively analysed and identified. A rapid, reproducible, direct injection capillary column gas chromatographic method was developed for the concentration and detection of such volatiles at mg/l and lower concentrations. Of at least forty volatiles detected, twenty-one were identified. The mean concentration of one of these, 3-methylbutanal, was found to be significantly elevated (p less than 0.01) in chronic encephalopathics (2.37 +/- 0.79 mg/l, n = 18), when compared to the controls (0.30 +/- 0.08 mg/l, n = 20). Furthermore, the concentration of this component increased with the clinically diagnosed severity of the encephalopathic state. The presence of 3-methylbutanal is related to leucine, a branched-chain amino acid linked with hepatic encephalopathy.