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September 1961

Blood AmmoniaExperimental and Clinical Reduction by Hypothermia

Author Affiliations

From the Department of Surgery, University of Cincinnati, and Veterans Administration Hospital, Cincinnati.

Arch Surg. 1961;83(3):348-355. doi:10.1001/archsurg.1961.01300150022003

Gastrointestinal bleeding threatens the cirrhotic patient with exsanguination and a frequently fatal disturbance of the central nervous system. The understanding and treatment of blood loss is more advanced than the control of hepatic coma. In 1896 Nencki and Pawlow1 indicted blood ammonia in meat intoxication. McDermott,2 Mann,3 and Levine4 demonstrated that blood ammonia levels were frequently elevated after an Eck fistula. McDermott,2 correlated these elevations with the episodic stupor following portal systemic anastomosis. An increase of blood ammonia is common in hepatic coma.5,6 The experimental elevation of blood ammonia produced a neurological syndrome similar to hepatic coma.7-9 Gastrointestinal administration of protein, especially blood, in these experiments confirms the clinical necessity of controlling blood loss, eliminating the blood lost, and reducing the metabolism of blood retained in the stomach and intestines. Blood digested in the gastrointestinal tract causes a prompt rise in the portal

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