Hepatic coma, a consequence of severe liver disease, is usually associated with elevated levels of blood ammonia and derangements of serum electrolytes and pH. Treatment of hepatic coma may be directed toward lowering of the blood ammonia level once this elevation has occurred or preventing the absorption of the products of protein digestion within the gastrointestinal tract.Several methods have been employed to control blood ammonia. Neomycin is useful in removing urea-splitting organisms from the intestine, thereby limiting the amount of ammonia absorbed into the portal circulation.1 The side effects of neomycin treatment, however, impair its usefulness. Hypothermia lowers blood ammonia, probably by limiting bacterial action.2,3 Arginine and glutamic acid4-6 enjoyed brief popularity because of the belief that they aided the metabolism of ammonia and its elimination via the Krebs urea cycle. Hemodialysis7 is effective in clearing the blood of ammonia, but the technique is
ZUIDEMA GD, CULLEN D, KOWALCZYK RS, WOLFMAN EF. Blood Ammonia Reduction by Potassium Exchange Resin: Experimentation in Eck-Fistula Dogs. Arch Surg. 1963;87(2):296–300. doi:10.1001/archsurg.1963.01310140104018
Monkeypox Resource Center
Customize your JAMA Network experience by selecting one or more topics from the list below.