SHUNT ENCEPHALOMYELOPATHY. I. RECURRENT PROTEIN ENCEPHALOPATHY WITH RESPONSE TO ARGININE

Abstract

The occurrence of severe and progressive protein intolerance with recurrent episodes of protein precoma or coma following the combination of cirrhosis, gastrectomy and portacaval shunt has been described in three patients. The gastrectomy appeared to augment the effects of the portacaval shunt. The recurrent episodes of protein precoma or coma responded sensitively to intravenous arginine in large dosage. The marked and progressive protein sensitivity led to body protein depletion and wasting. A persistent hyperchloremia was correlated with the protein depletion in two of the patients with portal cirrhosis and prolonged courses.