Liver Coma, With Particular Reference to Management

Abstract

COMA HAS long been recognized as an ominous manifestation of liver disease and as a frequent mode of death. In an attempt to learn more regarding etiologic factors, pathogenesis, chemical changes, and clinical course, 58 cases of liver disease characterized by coma were studied. It was hoped that a rational program of therapy could be formulated to improve the discouraging results noted in treating this condition to date.Fifty-eight cases of cirrhosis complicated by hepatic coma were selected from the records of the St. Louis City Hospital. All but one of the patients had died. Nearly all had been observed by one of us. Patients with lethargy or only mild stupor were not included, nor were patients in coma associated with massive hemorrhage. All but one of the patients had been in coma at least 24 hours. Reports of liver biopsies or autopsies were available in 41 cases. ETIOLOGICAL FACTORSIncidence.\p=m-\Inasmuchas these were selected cases, no accurate estimation of incidence is possible. During the period of study, 758 patients with cirrhosis of the liver were admitted to the St. Louis City Hospital. The incidence of cirrhosis in autopsy material at this hospital is reported as 2.2%.1 Elsewhere, coma has been reported as complicating cirrhosis in from 16% 2 to 42% 3 of the cases studied.Sex and Age.--Men predominated over women, 39 to 19. The ages ranged from 31 to 74 years for men, with an average of 54.6, and from 36 to 80 for women, with an average of 53.6 years; 68% of all patients studied were between the ages of 40 and 59 years.

Liver and Brain

“…It is well known that the so-called liver function tests are not different in liver patients with and without cerebral disturbances (Marner, 1949;Ricketts, Kirsner and Palmer, 1950;Switser, Steigmann, de la Huerga and Schaffner, 1952; Karl, Howell, Hutchinson and Cantanzaro, 1953; De Groote, I959). There is, nevertheless, someparallelism between the severity of liver dys-function and function tests on the one hand and the disturbance of liver metabolism on the otherhand.…”

Accelerated human liver progenitor generation from pluripotent stem cells by inhibiting formation of unwanted lineages

“…Attesting to the liver's importance, acute liver failure rapidly results in coma or death as toxins 35 accumulate in the body (Karl et al, 1953). However the sequence of lineage intermediates through which early hepatocytes develop from pluripotent cells remains to be fully defined, as are the extracellular signals that specify liver fate at each lineage juncture.…”