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Antibiotic Therapy in the Management of Hepatic Coma

BERNHARD B. FAST, M.D.; STANLEY J. WOLFE, M.D.; JAMES M. STORMONT, M.D.; CHARLES S. DAVIDSON, M.D.
AMA Arch Intern Med. 1958;101(2):467-475. doi:10.1001/archinte.1958.00260140299041.
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Hepatic coma is a metabolic disturbance occurring in some patients with liver disease which manifests itself as a "disorder of consciousness." The clinical features of the syndrome have been defined by Adams and Foley,1 providing criteria for diagnosis and a background for the investigation of its pathogenesis. The relationship between this disorder and toxic nitrogenous substances is generally recognized.2 These toxic substances, including ammonia, are believed to be a product of bacterial enzymatic action within the intestine.3 Antibacterial agents effective against intestinal organisms have been reported to improve prognosis in hepatic coma. 4,5,7 Assessment of results is complicated by the simultaneous utilization of a number of therapeutic measures and by the varied prognosis of the syndrome. Studies such as that reported by Fisher and Faloon 6 of patients with episodic stupor, whether spontaneous or following portacaval anastomosis, allow more controlled observations related to isolated therapeutic efforts. We with

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