The Effect of Sodium Glutamate on Hepatic Coma 12

Ammonium Uptake by the Extremities and Brain in Hepatic Coma, 12

“…Patients in the "coma" group were divided into one group without an added nitrogen load and a second group of patients with an added nitrogen load in the form of blood in their gastrointestinal tracts (evidence of upper gastrointestinal hemorrhage or massive epistaxis and blood swallowing). Pertinent clinical and laboratory data on all patients are presented in Tables I, II and III. Patients were observed on the wards of Cleveland City Hospital, Crile Veterans Administration Hospital, and Boston City Hospital.5 Confusion, coma and "flapping" tremor were graded from first to fourth degree; first degree indicated a mild, and fourth degree a serious, disturbance for each condition as previously described (20) (21). When steroids, acetazolamide (Diamox®g), analgesics or sedatives were given it is so indicated in the tables because some of these drugs have been used in the treatment of impending hepatic coma or have been implicated in its production.…”

“…When steroids, acetazolamide (Diamox®g), analgesics or sedatives were given it is so indicated in the tables because some of these drugs have been used in the treatment of impending hepatic coma or have been implicated in its production. The patients studied received neither glutamic acid nor arginine which may lower blood NH4-N concentrations (20,(22)(23)(24)(25). Neomycin and tetracycline antibiotics also may lower blood NH4-N concentrations in some patients with hepatic disease (26).…”

Management of Hepatocerebral Intoxication

“…The lack of correlation between venous ammonia values and the presence and severity of symptoms,'l7 [32][33][34][35][36] be related to muscle uptake, pH change or to enzyme alteration and adaptation.…”

Biochemical Observations on the Use of L-Glutamic Acid in the Treatment of Hepatic Coma

“…The criteria for the definition of coma are those outlined by Webster and Davidson (13). All patients were fasting during the time of study and glucose was administered at a constant rate as far as possible.…”

“…Walshe (6) reported in 1953 the successful treatment of hepatic coma with large amounts of 1-glutamic acid. Although beneficial results have been reported with glutamic acid by some investigators (7)(8)(9)(10)(11), in contrast, no benefit has been observed from this treatment by others (12)(13)(14). However, independent of the clinical result the blood ammonia decreases with glutamic acid therapy (7,12,14).…”