Ammonia Intoxication in a Patient with Congestive Heart Failure Receiving Ammonium Chloride Orally

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Abstract
THE liver in chronic congestive heart failure is usually enlarged and often tender, and shows histologic alterations of the lobules, particularly in their central portion.1 2 3 In more advanced cases the morphologic changes spread peripherally and may include fibrosis of the periportal areas as well. The physiologic counterpart of the anatomic lesion has been well documented by numerous investigations.1 , 4 5 6 7 More recent studies have shown that the degree of altered function and morphology tends to correlate with the severity of the heart failure.1 , 5 Evidence of cerebral dysfunction such as drowsiness, confusion, lethargy and even coma is occasionally associated with severe congestive heart . . .