We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Article |


William H. J. Summerskill, D.M., M.R.C.P.; Stanley J. Wolfe, M.D.; Charles S. Davidson, M.D.
AMA Arch Intern Med. 1956;97(6):661-663. doi:10.1001/archinte.1956.00250240013001.
Text Size: A A A
Published online


AMMONIA intoxication has yet to be established as the causal factor in hepatic coma, although several observations suggest this to be the case. Nevertheless, the significance of high blood ammonia values in liver disease and the influence that recent advances in this field should exert on treatment demand critical review.

Ammonia metabolism had been intimately related to liver function even before Krebs gave precise details of the synthesis of urea from ammonia in the liver. The greatest concentration of ammonia is in portal vein blood after protein ingestion, reflecting enzymatic activity on dietary nitrogen. Values higher than in peripheral veins are found in renal vein blood, and recent work has indicated that the arterial concentration is higher than peripheral venous.1 It is possible also that ammonia may be derived from other sources. Elevated fasting peripheral blood ammonia levels in certain patients with hepatic cirrhosis were originally attributed to shunting of portal blood through collateral vessels, an explanation in accord with observations made


Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview





Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

0 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.