Blood Ammonia during Bleeding from Esophageal Varices in Patients with Hepatosplenic Schistosomiasis

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Abstract
HEPATIC coma1 , 2 is responsible for a significant proportion of the high case fatality rate occurring during episodes of bleeding esophageal varices in patients with cirrhosis of the liver.1 2 3 4 The etiology of coma in such cases has been related to the marked elevation of peripheral blood ammonia concentrations occurring during and immediately after the hemorrhages.5 , 6 Patients with hepatosplenic schistosomiasis, however, are said to suffer a relatively low case fatality during episodes of hematemesis, and the development of hepatic coma is supposedly rare.7 8 9 To elucidate the reasons for these differences, arterial and venous ammonia concentrations were measured during episodes of bleeding esophageal . . .