DISEASES OF THE LIVER: HEPATIC COMA
This is a complication of severe liver disease caused by a high blood level of ammonia. The ammonia is produced in the intestinal tract by bacterial action. It is especially likely to occur following gastrointestinal hemorrhage, surgery, or the use of a high-protein diet in severe liver disease. The ammonia that enters the general circulation from the intestinal tract is toxic to the central nervous system so that the typical symptoms are drowsiness, irritability, restlessness, poor coordination of the arms and legs, fecal odor to the breath, and eventually loss of consciousness.
Dietary management. The administration of antibiotics to reduce bacterial growth and hence the production of ammonia in the intestines is often sufficient to correct the condition. If this is not adequate, the diet is modified as follows:
1. Sufficient calories from carbohydrate and fat to prevent tissue breakdown; about 1500 to 2000 kcal.
2. Protein-free to low-protein diet – about 20 to 30 gm protein – for a few days.
With improvement the diet is cautiously increased by 10 gm protein every few days until a normal diet is again achieved. Many patients use a 40 to 50 gm-protein diet for long periods of time.
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GENERAL HEALTH

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