BIOCHEMICAL OBSERVATIONS ON THE USE OF L-GLUTAMIC ACID IN THE TREATMENT OF HEPATIC COMA

Abstract

Sodium glutamate (about 24 g) was infused intravenously a total of 13 times in 2 normal subjects and 8 patients with cirrhosis. The blood ammonia levels fell in 11 of 12 and the blood alpha-ketoglutarate levels rose in 8 of 10 instances. The changes in blood pyruvate and citrate were variable. Glutamine levels showed variable changes but did not rise sufficiently in all cases to account for the lowering of the blood ammonia by the conversion of glutamic acid to glutamine. The pattern of response to glutamic acid infusion was similar for normal subjects, patients with cirrhosis and patients with hepatic coma, although the initial levels of these substances were elevated in the patients with cirrhosis. Only one of the 7 patients in hepatic coma showed a suggestive clinical response to sodium glutamate infusion.