Night shift and hyperammonemia in doctors

E.Yu. Plotnikova¹, O.A. Vorosova², E.N. Baranova^1,2, M.S. Karyagina², K.A. Krasnov^1,2, M.A. Sinkov³

¹Kemerovo State Medical University, Kemerovo

²Kemerovo Clinical Emergency Hospital, Kemerovo

³Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo

Background: chronic circadian rhythm sleep disorder is associated with a variety of health risks, including sleep and gastrointestinal disorders, and cardiovascular diseases. Besides, lack of sleep and sleep disorders increase the incidence of dementia. Pathophysiological mechanisms of non-cirrhotic hyperammonemic encephalopathy are multifactorial and poorly understood.

Aim: to assess the degree of asthenia and cognitive impairment, ammonia level, and study the L-ornithine-L-aspartate (LOLA) effect in hyperammonemia in duty medical officers of the city emergency hospital.

Patients and Methods: 31 doctors of therapeutic and surgical profile aged from 22 to 45 years were under the follow-up. All doctors worked in the day shift and had 8–12-night shifts per month. Subjects in the clinical follow-up were examined for ammonia level before and after duty. After, they were asked to complete the Number Connecting Test and Subjective Scale of Asthenia. Eight doctors with the highest levels of ammonia during the next duty took 3 LOLA sachets. After the duty, these subjects were again examined the ammonia level in their blood and offered to complete tests in dynamics.

Results: initially, almost all doctors (n=31) had an increased level of ammonia in capillary blood to an average of 107.19±43.72 μg/dL and increased after the duty to an average of 133.81±69.60 μg/dL (p=0.047). Asthenia severity increased from 37.48±12.81 points to 47.16±15.33 points (p=0.0015). During LOLA intake (n=8), the ammonia level decreased from 181.00±57.7 µg/dL to 129.37±61.1 µg/dL (p=0.0000924). A slight increase in the asthenia severity was statistically insignificant (p=0.026).

Conclusion: we recommend that those medical officers who have increased working hours, night shift, fatigue and asthenia, should monitor the level of ammonia. Thus, if it increases, it shall be reduced to normal value with medication.

Keywords: night shift, asthenia, circadian rhythm disorder, dementia, hyperammonemia, L-ornithine-L-aspartate.

For citation: Plotnikova E.Yu., Vorosova O.A., Baranova E.N. et al. Night shift and hyperammonemia in doctors. RMJ. 2021;4:49–52.