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Article
December 1963

Liver-Brain Relationships in Hepatic ComaWith Special Reference to Ammonia and Keto Acid Metabolism

Arch Intern Med. 1963;112(6):899-916. doi:10.1001/archinte.1963.03860060123014
Abstract

In the century which has elapsed since the classical clinical description of Frerichs 1 of the neurological and mental changes in advanced liver failure, and especially since the studies in Pavlov's laboratory on meat intoxication in dogs with an Eck fistula,2 and the observation of a rise in blood ammonia in man by Kirk 3 and several others, ammonia and related amino acids and metabolites have held the center of the field in investigations attempting to elucidate the pathogenesis of hepatic coma. Subsequently Bessman et al4 showed an increased uptake of ammonia by the brain, and Fazekas et al 5 demonstrated a reduced cerebral oxygen consumption in hepatic coma. Critical and detailed reviews on this subject have come recently from Sherlock,6 Chalmers,7 Walshe,8 Dastur,9 and Seshadri.10

The main purpose of the present investigation was to reassess the role of ammonia and amino acids and of certain keto acids

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