The Syndrome of Impending Hepatic Coma in Patients with Cirrhosis of the Liver Given Certain Nitrogenous Substances

ONE of the serious complications of severe liver disease is the development of a comatose state that is frequently irreversible. Although hepatic coma is well recognized clinically, its onset has been difficult to predict, since no distinctive alterations in laboratory tests have been described.1 The diagnosis of impending hepatic coma has been clarified, however, by the clinical observations of Adams and Foley,2 who described mental disturbances and a characteristic tremor before the onset of the comatose state. In addition, a characteristic electroencephalographic pattern often occurs.3 A syndrome indistinguishable from impending hepatic coma has recently been described in patients with cirrhosis . . .