Oliguria and azotemia may accompany the development of hepatic coma in patients with severe liver disease, and they are frequently ominous prognostic signs. Since urea from the circulating blood enters the gastrointestinal tract where it can be degraded to ammonium by the action of bacterial urease,1 urea may be capable of contributing indirectly to the increased concentration of ammonium found in the blood of some patients with liver disease. Increased circulating urea might then be considered with other nitrogenous substances capable of inducing impending hepatic coma in patients with severe hepatic disease.2-7 This investigation was done to determine the influence of azotemia upon the blood ammonium levels in patients with hepatic disease and to evaluate the relation of azotemia to hepatic coma.
Materials and Methods
Four groups of patients were studied. One group consisted of six patients with azotemia but without liver disease (Table 1). A second group