Limonene in exhaled breath is elevated in hepatic encephalopathy

J Breath Res. 2016 Nov 21;10(4):046010. doi: 10.1088/1752-7155/10/4/046010.

Abstract

Breath samples were taken from 31 patients with liver disease and 30 controls in a clinical setting and proton transfer reaction quadrupole mass spectrometry (PTR-Quad-MS) used to measure the concentration of volatile organic compounds (VOCs). All patients had cirrhosis of various etiologies, with some also suffering from hepatocellular cancer (HCC) and/or hepatic encephalopathy (HE). Breath limonene was higher in patients with No-HCC than with HCC, median (lower/upper quartile) 14.2 (7.2/60.1) versus 3.6 (2.0/13.7) and 1.5 (1.1/2.3) nmol mol-1 in controls. This may reflect disease severity, as those with No-HCC had significantly higher UKELD (United Kingdom model for End stage Liver Disease) scores. Patients with HE were categorized as having HE symptoms presently, having a history but no current symptoms and having neither history nor current symptoms. Breath limonene in these groups was median (lower/upper quartile) 46.0 (14.0/103), 4.2 (2.6/6.4) and 7.2 (2.0/19.1) nmol mol-1, respectively. The higher concentration of limonene in those with current symptoms of HE than with a history but no current symptoms cannot be explained by disease severity as their UKELD scores were not significantly different. Longitudinal data from two patients admitted to hospital with HE show a large intra-subject variation in breath limonene, median (range) 18 (10-44) and 42 (32-58) nmol mol-1.

MeSH terms

  • Adult
  • Aged
  • Breath Tests / methods*
  • Cyclohexenes / metabolism*
  • Exhalation
  • Female
  • Hepatic Encephalopathy / diagnosis*
  • Humans
  • Limonene
  • Male
  • Middle Aged
  • Terpenes / metabolism*
  • Volatile Organic Compounds / analysis
  • Volatile Organic Compounds / metabolism*

Substances

  • Cyclohexenes
  • Terpenes
  • Volatile Organic Compounds
  • Limonene