Blood Ammonia in Chronic Pulmonary Emphysema

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Abstract
ELEVATION of blood ammonia concentration in patients with advanced liver disease either spontaneously or after the ingestion of ammonium salts,1 , 2 acetazolamide2 , 3 or chlorothiazide4 is well recognized. However, high levels have also been found in the presence of shock,5 congestive heart failure,6 7 8 diabetic coma1 and pneumonia superimposed on extensive pulmonary disease.1 Asterixis, the "flapping tremor" usually associated with liver disease, has been observed in some of the conditions in which high blood ammonia is found but has also been described in the absence of such an abnormality. Conn,8 in a recent review of the subject, emphasized the nonspecificity of asterixis as . . .

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