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September 28, 1957


JAMA. 1957;165(4):348-349. doi:10.1001/jama.1957.72980220005009b

Numerous recent publications have attested the significance of elevations in the levels of ammonia in the circulating blood of patients with certain liver diseases.1 Stuporous phenomena have been observed when the ammonia-nitrogen level of blood has exceeded 200 meg. per 100 ml. The blood of a healthy person contains minute amounts of ammonia, which increase when blood stands in an open container exposed to room air.2 In our laboratory, as in others, the ammonia level in the blood of a healthy person has been found not to exceed 50 meg. per 100 ml.

Stupor, or coma, occurs not infrequently during or following episodes of esophageal or gastrointestinal hemorrhage in patients with liver disease when there is interference with the passage of portal venous blood through the liver. It generally is agreed that a prime source of the increased ammonia content of the blood is the extravasated blood acted

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