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September 1, 1956


JAMA. 1956;162(1):63. doi:10.1001/jama.1956.02970180065021

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To the Editor:—  The recent article by Sievers and Vander, "Toxic Effects of Ammonium Chloride in Cardiac, Renal, and Hepatic Disease" (J. A. M. A.161:410 [June 2] 1956) and the recent extremely informative review by S. P. Bessman, "The Role of Ammonia in Clinical Syndromes" (editorial, Ann. Int. Med.44:1037, 1956) point up the importance of ammonia in the production of toxic cerebral effects in cardiac, renal, and hepatic disease. Although the article of Sievers and Vander refers to the production of toxic cerebral effects after treatment with ammonium chloride, it is now known that the blood ammonia level is elevated in certain patients with heart failure, even without treatment with ammonium chloride ( Bessman, A. N., and Evans, J. M.: Am. Heart J.50:715, 1955). These workers showed a parallelism between the blood ammonia level and the mental state. It is generally held today that the

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