Management of Hepatocerebral Intoxication

Abstract

THERAPY for patients with actual or impending hepatic coma has been unsatisfactory in the majority of cases, being hindered by a lack of knowledge regarding the fundamental alterations of metabolic processes that occur in this syndrome of combined liver failure and Central-nervous-system dysfunction. Recently, considerable evidence has accumulated that defective nitrogen metabolism is intimately involved in the genesis of hepatic coma^{1 2 3 4 5 6 7}; such a defect is associated with the diminished removal of ammonia as urea by the liver.Progressive mental changes, deterioration in the state of consciousness, variable neurologic deficit, flapping tremor, fetor hepaticus, elevated blood ammonia and electroencephalographic abnormalities . . .