Pathogenesis and Management of Hepatic Coma
This is a concise summary of the present state of knowledge concerning pathogenesis and treatment of hepatic coma by one of the leading students of the subject. Particular attention is given to the recent developments regarding the relation of toxic effects of ammonium compounds on the central nervous system. It is recommended that during the acute phase of hepatic coma all dietary intake of protein should be stopped. Neomycin is given to diminish the bacterial action in the intestine, which is thought to produce toxic products contributing to central nervous system manifestations. The results of therapy with such compounds as glutamic acid, arginine and ornithine have been disappointing and these are not recommended for routine use. The place of adrenal corticoid hormones in the treatment of hepatic coma and hepatitis is discussed. The author finds the results of this form of therapy difficult to evaluate but concludes that their use in fulminant hepatitis is probably wise. Other details in the practical management of hepatic coma, an analysis of results of treatment and discussion of prognosis, are also included in the discussion.
