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Hepatic coma

Presentation and discussion of case

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Summary

The neurologic symptoms accompanying severe liver disease have been termed hepatic coma. This syndrome is characterized by personality changes, inappropriate behavior, stupor, and eventually coma. The peculiar flapping tremor is the most characteristic physical finding. Abnormalities of the electroencephalogram have been correlated with the depth of coma. The neuropathologic changes accompanying hepatic coma are limited to a diffuse protoplasmic astrocytosis.

The most frequent biochemical abnormality is an elevation of the blood ammonia. This results from the breakdown of nitrogenous products in the bowel which reach the brain in toxic quantities as the result of portal venous collateral circulation around the liver and/or as the result of defective liver function.

Treatment is directed toward improving liver function and removing the toxic breakdown products of gastrointestinal hemorrhage from the bowel. Administration of sodium glutamate has been used with variable results. Similar observations have been reported concerning the value of adrenal steroid therapy and administration of oral antibiotics.

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Authors and Affiliations

  1. Gastroenterology Laboratory, Northwestern University Medical School, 303 East Chicago Ave., Chicago 11, Ill.

    E. Clinton Texter Jr. M.D. & Craig W. Borden M.D. (editors)

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  1. E. Clinton Texter Jr. M.D.
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  2. Craig W. Borden M.D.
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Clinton Texter, E., Borden, C.W. Hepatic coma. Digest Dis Sci 3, 159–177 (1958). https://doi.org/10.1007/BF02232388

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