肝臓疾患に於けるアンモニア代謝の研究
1962 年 59 巻 4 号 p. 217-231
詳細
1962 年 59 巻 4 号 p. 217-231
Blood ammonia concentration in liver diseases was studied with special reference to its relation to hepatic coma.
1) Blood ammonia level was determined by the microdiffusion method of Conway. Elevated blood ammonia level was observed in the patients with liver diseases with the exception of obstructive jaundice and higher level was observed in the patients with hepatic coma. However, the overlapping of the values between these three groups was observed and blood ammonia level did not always correlate with the clinical condition.
2) In some patients with liver diseases, the oral administration of antibiotics which supress the bacterial growth in making ammonia in intestine, and the parenteral administration of arginine, an activator of urea cycle in the liver were effective against hepatic coma, resulting in lowering of blood ammonia.
3) Hepatic coma with hyperammoniemia was provoked in some patients with liver diseases by the administration of chlorothiazide, hydrochlorothiazide and mercury diuretics.
4) A case with probably hepatocerebral syndrome was observed for one and half year. This patient had frequent attacks of unconsciousness and was also provoked by acetazolamide and high intake of protein. These attacks were fairly good correlated with hyperammoniemia.
In summary, ammonia intoxication seems to play an important role in the genesis of hepatic coma.
