Recurrent Psychosis Associated with Liver Disease and Elevated Blood Ammonia
N Engl J Med 1955; 252:756-759May 5, 1955DOI: 10.1056/NEJM195505052521804
AN increasing body of evidence suggests that ingestion of dietary protein or some other nitrogenous substances may, under certain conditions, precipitate hepatic coma or impending hepatic coma.1 2 3Adams and Foley4 and Foley et al.5 have detailed the clinical and laboratory signs of impending hepatic coma. These include a “flapping tremor,” electroencephalographic abnormalities and changes in mental status, chiefly “reduction of awareness, followed by a brief period of quiet delirium” progressing to stupor.5 The blood ammonia nitrogen level may be elevated.1 2 3 The changes in mental function reported after protein administration have usually been transient and reversible. In the case reported below . . .
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