Effect of Arginine and Glutamate on the Removal of Ammonia from the Blood in Normal and Cirrhotic Patients

Abstract

THE increasing documentation of a specific toxic effect of ammonia^{1 2 3 4 5 6} as the cause of mental symptoms in a number of clinical conditions stimulates interest in methods of removing, or increasing the metabolism of, this intermediate.Two compounds have been suggested as therapeutic agents, glutamate and arginine. Glutamate, first demonstrated to be effective in animals by Sapirstein⁷ and used clinically by Walshe,⁸ is supposed to act by stimulating the synthesis of glutamine, and arginine, suggested by Greenstein's⁹ group, stimulates urea synthesis by providing intermediates for the urea cycle. Both these agents have been compared in patients with and without liver disease . . .