Recently, as the genesis of hepatic coma, the blood ammonia concentration and its “up-take” in the brain, have been subjects of considerable debate. Using the Conway's microdiffusion method, the arterial blood ammonia concentrations (ANH
3), the cerebral venous blood ammonia concentrations (CVNH
3), and the cerebral arterio-venous blood ammonia differences (CA-VNH
3) were measured respectively in 15 normal subjects, 34 cases of liver diseases, 36 cases of psychoneurological disorders, 15 cases of hypertension, 4 cases of diabetes mellitus, and 3 cases of Graves' disease. Additionally, the cerebral hemodynamics were studied in 15 patients with liver disease.
1) In the normal subjects, ANH
3 was 0.20±0.28μg/cc, and CA-VNH
3 was -0.01±0.09μg/cc. No significant difference between ANH
3 and CVNH
3 was recognized.
2) In 6 patients suffering from liver tumor, ANH
3 was significantly increased, and in 10 patients with liver cirrhosis, increase of ANH
3 and CA-VNH
3 were significant. In 15 patients with hepatitis and 2 patients in congested liver, increase of ANH
3 and CA-VNH
3 were not distinct.
3) In 8 liver cirrhosis, decreased CBF, increased MABP, elevated CVR, and depressed CMRO
2 were observed. In 2 cases of hepatic precoma, CBF was slightly decreased, while CVR and CMRO
2 were slightly increased. In 2 patients with hepatic coma remarkable decrease of CBF, elevation of CVR and exceeding depression of CMRO
2 were observed. There was a significant negative correlation between ANH
3 and CMRO
2.
4) In 3 cases of hypnotic coma and 15 of shizophrenics, no change in blood ammonia concentration were observed. But in 2 cases of 3 apoplectic coma, ANH
3 and CA-VNH
3 were elevated.
5) In the patients with insulin coma, blood ammonia level was not significantly changed. After the electric shock therapy was given, ANH
3 and CA-VNH
3 were significantly increased. At the same time, remarkable metabolic acidosis was observed.
6) In liver disease and after electric shock therapy was given, a significant correlation between ANH
3 and CA-VNH
3 was noted. The above mentioned facts lead to the conclusion that, in the hyperammoniemia and to be sure in the liver disease, “up-take” of the ammonia in the brain might usually observed.
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