COMA HAS long been recognized as an ominous manifestation of liver disease and as a frequent mode of death. In an attempt to learn more regarding etiologic factors, pathogenesis, chemical changes, and clinical course, 58 cases of liver disease characterized by coma were studied. It was hoped that a rational program of therapy could be formulated to improve the discouraging results noted in treating this condition to date.
Fifty-eight cases of cirrhosis complicated by hepatic coma were selected from the records of the St. Louis City Hospital. All but one of the patients had died. Nearly all had been observed by one of us. Patients with lethargy or only mild stupor were not included, nor were patients in coma associated with massive hemorrhage. All but one of the patients had been in coma at least 24 hours. Reports of liver biopsies or autopsies were available in 41 cases.