Production of Impending Hepatic Coma by Chlorothiazide and Its Prevention by Antibiotics

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Abstract
DEVELOPMENT of impending hepatic coma, characterized by confusion, drowsiness and flapping tremor, has been described previously in patients with cirrhosis given nitrogenous substances by mouth — ammonium cation-exchange resins, ammonium salts, urea, methionine and increments in dietary protein.1 2 3 It has also been reported in patients given a carbonic anhydrase inhibitor, acetazolamide.4 We wish to report the production of impending hepatic coma in alcoholic patients with cirrhosis and ascites given chlorothiazide,∥ a nonmercurial diuretic agent. Its prevention by concurrent oral administration of broad-spectrum, nonabsorbable antibiotics was also observed.Materials and MethodsFive patients (4 males and 1 female) with alcoholic cirrhosis . . .