Production of Impending Hepatic Coma by Chlorothiazide and Its Prevention by Antibiotics

Abstract

DEVELOPMENT of impending hepatic coma, characterized by confusion, drowsiness and flapping tremor, has been described previously in patients with cirrhosis given nitrogenous substances by mouth — ammonium cation-exchange resins, ammonium salts, urea, methionine and increments in dietary protein.^{1 2 3} It has also been reported in patients given a carbonic anhydrase inhibitor, acetazolamide.⁴ We wish to report the production of impending hepatic coma in alcoholic patients with cirrhosis and ascites given chlorothiazide,∥ a nonmercurial diuretic agent. Its prevention by concurrent oral administration of broad-spectrum, nonabsorbable antibiotics was also observed.Materials and MethodsFive patients (4 males and 1 female) with alcoholic cirrhosis . . .