MARKEDLY ELEVATED BLOOD AMMONIA IN A PATIENT WITH CONSTRICTIVE PERICARDITIS

1 April 1961

journal article
research article
Published by American College of Physicians in Annals of Internal Medicine

Vol. 54 (4) , 799-805
https://doi.org/10.7326/0003-4819-54-4-799

Abstract

A 51-year-old male truck driver was treated for refractory heart failure due to far advanced constrictive pericarditis of unknown etiology. His blood ammonia level rose to almost 800 ug%. The ammonium ion intoxication responded poorly to oral neomycin and intravenous arginine. After surgical relief of the constrictive pericarditis, his blood ammonia dropped gradually to 150 [image]g %. A liver biopsy showed only chronic, passive hyperemia and cloudy swelling, and liver function tests were normal. It is postulated that the elevated blood ammonia was due to a portal by-pass caused by the constriction of the inferior vena cava near the heart.

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