Recurrent Psychosis Associated with Liver Disease and Elevated Blood Ammonia

  • Leston L. Havens, M.D.,
  • and Charles G. Child, III, M.D.


This article has no abstract; the first 100 words appear below.

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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