Clinical Experience with the Use of Neomycin in Hepatic Coma

The occurrence of mental changes in patients with cirrhosis following the administration of ammonium-containing substances or ammonium precursors ^1,2 has stimulated the use of measures designed to reduce blood ammonia concentrations in patients with hepatic coma. Of the many regimens which have been employed, simultaneous protein withdrawal and oral administration of widespectrum antibiotics have been reported to give the most favorable results.^3,4 These measures have yielded a higher rate of improvement and survival in coma or impending coma than has the use of sodium glutamate, adrenal steroids, and other compounds, particularly when these are used in conjunction with continued protein feeding.⁴ Although perhaps more extensively used than any other agent, glutamic acid salts have not been unanimously accepted as worth-while agents.^5-9 Promising results have been reported with the use of arginine,¹⁰ but confirmation has been lacking.^11,12 The major criticism of the studies of both glutamate and arginine is that in