Blood Ammonia Reduction by Potassium Exchange Resin

Abstract

Introduction 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.1The side effects of neomycin treatment, however, impair its usefulness. Hypothermia lowers blood ammonia, probably by limiting bacterial action.2,3Arginine and glutamic acid4-6enjoyed brief popularity because of the belief that they aided the metabolism of ammonia and its elimination via the Krebs urea cycle. Hemodialysis7is effective in clearing the blood of ammonia, but the technique is