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February 1967

Amino Acids Mixtures in Prevention of Acute Ammonia Intoxication in Dogs

Author Affiliations

New York
From the Department of Surgery, St. Vincent's Hospital and Medical Center of New York, and the New York University School of Medicine, New York.

Arch Surg. 1967;94(2):261-266. doi:10.1001/archsurg.1967.01330080099025

HEPATIC encephalopathy continues to present a serious complication in patients following portasystemic shunt. It results from multiple metabolic derangements in patients with chronic liver disease and hepatocellular damage and is related to a disturbance of ammonia metabolism. It has been extensively studied by Sherlock and associates,1 McDermott,2 Zuidema and associates,3 and others. Although other toxic substances have been implicated, the most commonly found metabolic product of protein metabolism that is indictable in its genesis is ammonia.

Our current concepts of management are oriented in attempts to limit exogenous sources of proteins and inhibition of bacterial decomposition in the colon with antibiotics. In addition, other methods of treatment of encephalopathy and ammonia intoxication have consisted of use of cation exchange resin, amino acid therapy with glutamic acid, and arginine, hemodialysis, isolated liver perfusion, total blood exchange and replacement, and finally colectomy or colon exclusion. In spite of vigorous

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