Blood ammonia and electrolytes in hepatic coma.

Abstract

Abstract Twenty-two patients with cirrhosis have been observed clinically in various stages of hepatic coma. Serial biochemical measurements of serum pH, carbon dioxide content, and chloride, sodium, and potassium concentrations, and of blood nonprotein nitrogen and ammonia content, and of hematocrit and hemoglobin were made. Twenty of these patients died in hepatic coma. The presence of a "flapping" tremor was a grave prognostic sign. Characteristic electroencephalographic patterns were found in five of the seven patients in whom tracings were taken. The mean data indicated no abnormality in acid-base equilibrium of the blood; however, a consistently diminished serum sodium and chloride concentration was noted in the patients with coma. This has been related to the presence of ascites and in some patients to oliguria and abnormally large fluid intakes. No correlation between individual biochemical abnormalities of sodium, chloride, potassium, or acid-base equilibrium and clinical status was evident. In individual cases, such abnormalities may play a contributory role in the development of hepatic coma. Elevation of the blood ammonia was noted in patients with cirrhosis of the liver, both with and without impending coma or coma. No precise correlation in serial measurements was noted between blood ammonia level and degree of consciousness.