Diversion of Urine to the Intestines as a Factor in Ammoniagenic Coma

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Abstract
THE studies from this laboratory1 2 3 4 on the subject of ammonia metabolism, which were initiated by the delineation of the syndrome of ammonia intoxication in a patient with an Eck fistula,5 led to an exploration of the metabolic disturbances recognized as a frequent sequela to the construction of ureteroenterostomies in man.After urinary flow has been diverted into the gastrointestinal tract a series of metabolic changes may occur that result in the syndrome of "hyperchloremic acidosis." A number of reports and studies on this syndrome and on the mechanisms involved have appeared in the past few years,6 7 8 9 10 11 and a detailed review . . .