THE PLASMA “AMMONIA” AND GLUTAMINE CONTENT IN PATIENTS WITH HEPATIC COMA 1

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Abstract
The specific glutaminase of Clostridium welchii SR-12 was adapted for quantitative analysis of plasma glutamine. Plasma from normal adults and patients with cirrhosis of the liver was assayed for the content of glutamine and volatile base (ammonia) liberated during microdiffusion. The patients with cirrhosis were sub-classified according to impending hepatic coma and hepatic coma. The values for plasma glutamine were similar in all groups evaluated. The volatile base, "ammonia," was elevated in the impending hepatic coma and hepatic coma groups. No correlation between plasma glutamine and neurological status of the patients with cirrhosis was noted. A suggestive correlation of neurological status and the plasma "ammonia" was evident in the mean values for the groups; however, this was not consistently present in serial measurements in individual patients. The characteristic neurological findings of impending hepatic coma were produced in 1 of 3 patients in whom elevated plasma "ammonia" levels were produced by the infusion of ammonium chloride without any effect on the concn. of plasma glutamine.