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. 1978 Jun;19(6):504–509. doi: 10.1136/gut.19.6.504

Regulation of blood ammonia.

A M Dawson
PMCID: PMC1412040  PMID: 355065

Abstract

Disturbance of ammonia metabolism is an important but not the only factor in the genesis of hepatic coma. In this review mechanisms controlling the concentration of ammonia in the blood other than disturbed liver function have been discussed. The key function of ammonia in the pyridine nucleotide cyde has been outlined and it is suggested that the function of this cycle in patients with liver disease would repay further study.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. ALLEN S. I., CONN H. O. Observations on the effect of exercise on blood ammonia concentration in man. Yale J Biol Med. 1960 Oct;33:133–144. [PMC free article] [PubMed] [Google Scholar]
  2. Agostini L., Down P. F., Murison J., Wrong O. M. Faecal ammonia and pH during lactulose administration in man: comparison with other cathartics. Gut. 1972 Nov;13(11):859–866. doi: 10.1136/gut.13.11.859. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Aoyagi T., Summerskill W. H. Inhibition by acetohydroxamic acid of human mucosal and faecal urease-specific activity. Lancet. 1966 Feb 5;1(7432):296–297. doi: 10.1016/s0140-6736(66)90643-x. [DOI] [PubMed] [Google Scholar]
  4. BESSMAN S. P., BESSMAN A. N. The cerebral and peripheral uptake of ammonia in liver disease with an hypothesis for the mechanism of hepatic coma. J Clin Invest. 1955 Apr;34(4):622–628. doi: 10.1172/JCI103111. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. BORGSTROM B., DAHLQVIST A., LUNDH G., SJOVALL J. Studies of intestinal digestion and absorption in the human. J Clin Invest. 1957 Oct;36(10):1521–1536. doi: 10.1172/JCI103549. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Billich C. O., Levitan R. Effects of sodium concentration and osmolality on water and electrolyte absorption form the intact human colon. J Clin Invest. 1969 Jul;48(7):1336–1347. doi: 10.1172/JCI106100. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Bircher J., Müller J., Guggenheim P., Haemmerli U. P. Treatment of chronic portal-systemic encephalopathy with lactulose. Lancet. 1966 Apr 23;1(7443):890–892. doi: 10.1016/s0140-6736(66)91573-x. [DOI] [PubMed] [Google Scholar]
  8. Bown R. L., Gibson J. A., Sladen G. E., Hicks B., Dawson A. M. Effects of lactulose and other laxatives on ileal and colonic pH as measured by a radiotelemetry device. Gut. 1974 Dec;15(12):999–1004. doi: 10.1136/gut.15.12.999. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Brown R. L., Gibson J. A., Fenton J. C., Snedden W., Clark M. L., Sladen G. E. Ammonia and urea transport by the excluded human colon. Clin Sci Mol Med. 1975 Apr;48(4):279–287. doi: 10.1042/cs0480279. [DOI] [PubMed] [Google Scholar]
  10. Castell D. O., Moore E. W. Ammonia absorption from the human colon. The role of nonionic diffusion. Gastroenterology. 1971 Jan;60(1):33–42. [PubMed] [Google Scholar]
  11. Daniel P. M. The metabolic homoeostatic role of muscle and its function as a store of protein. Lancet. 1977 Aug 27;2(8035):446–448. doi: 10.1016/s0140-6736(77)90622-5. [DOI] [PubMed] [Google Scholar]
  12. Fordtran J. S., Rector F. C., Jr, Ewton M. F., Soter N., Kinney J. Permeability characteristics of the human small intestine. J Clin Invest. 1965 Dec;44(12):1935–1944. doi: 10.1172/JCI105299. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Gibson J. A., Park N. J., Sladen G. E., Dawson A. M. The role of the colon in urea metabolism in man. Clin Sci Mol Med. 1976 Jan;50(1):51–59. doi: 10.1042/cs0500051. [DOI] [PubMed] [Google Scholar]
  14. Gibson J. A., Sladen G. E., Dawson A. M. Protein absorption and ammonia production: the effects of dietary protein and removal of the colon. Br J Nutr. 1976 Jan;35(1):61–65. doi: 10.1079/bjn19760009. [DOI] [PubMed] [Google Scholar]
  15. Jones E. A., Smallwood R. A., Craigie A., Rosenoer V. M. The enterohepatic circulation of urea nitrogen. Clin Sci. 1969 Dec;37(3):825–836. [PubMed] [Google Scholar]
  16. McDERMOTT W. V., Jr, ADAMS R. D. Episodic stupor associated with an Eck fistula in the human with particular reference to the metabolism of ammonia. J Clin Invest. 1954 Jan;33(1):1–9. doi: 10.1172/JCI102862. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Nance F. C., Batson R. C., Kline D. G. Ammonia production in germ-free Eck fistula dogs. Surgery. 1971 Aug;70(2):169–174. [PubMed] [Google Scholar]
  18. PHILLIPS G. B., SCHWARTZ R., GABUZDA G. J., Jr, DAVIDSON C. S. The syndrome of impending hepatic coma in patients with cirrhosis of the liver given certain nitrogenous substances. N Engl J Med. 1952 Aug 14;247(7):239–246. doi: 10.1056/NEJM195208142470703. [DOI] [PubMed] [Google Scholar]
  20. Resnick R. H., Ishihara A., Chalmers T. C., Schimmel E. M. A controlled trial of colon bypass in chronic hepatic encephalopathy. Gastroenterology. 1968 Jun;54(6):1057–1069. [PubMed] [Google Scholar]
  21. SCHWARTZ A. E., LAWRENCE W., Jr, ROBERTS K. E. Elevation of peripheral blood ammonia following muscular exercise. Proc Soc Exp Biol Med. 1958 Jul;98(3):548–550. doi: 10.3181/00379727-98-24103. [DOI] [PubMed] [Google Scholar]
  22. SHERLOCK S., SUMMERSKILL W. H., WHITE L. P., PHEAR E. A. Portal-systemic encephalopathy; neurological complications of liver disease. Lancet. 1954 Sep 4;267(6836):454–457. [PubMed] [Google Scholar]
  23. SUMMERSKILL W. H., DAVIDSON E. A., SHERLOCK S., STEINER R. E. The neuropsychiatric syndrome associated with hepatic cirrhosis and an extensive portal collateral circulation. Q J Med. 1956 Apr;25(98):245–266. [PubMed] [Google Scholar]
  24. SUMMERSKILL W. H., WOLFE S. J., DAVIDSON C. S. The metabolism of ammonia and alpha-keto-acids in liver disease and hepatic coma. J Clin Invest. 1957 Mar;36(3):361–372. doi: 10.1172/JCI103432. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Sinniah D., Fulton T. T., McCullough H. The effect of exercise on the venous blood ammonium concentration in man. J Clin Pathol. 1970 Nov;23(8):715–719. doi: 10.1136/jcp.23.8.715. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Summerskill W. H. On the origin and transfer of ammonia in the human gastrointestinal tract. Medicine (Baltimore) 1966 Nov;45(6):491–496. doi: 10.1097/00005792-196645060-00012. [DOI] [PubMed] [Google Scholar]
  27. Vince A., Dawson A. M., Park N., O'Grady F. Ammonia production by intestinal bacteria. Gut. 1973 Mar;14(3):171–177. doi: 10.1136/gut.14.3.171. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. WEBSTER L. T., Jr, GABUZDA G. J. Relation of azotemia to blood ammonium in patients with hepatic cirrhosis. AMA Arch Intern Med. 1959 Jan;103(1):15–22. doi: 10.1001/archinte.1959.00270010021004. [DOI] [PubMed] [Google Scholar]
  29. WHITE L. P., PHEAR E. A., SUMMERSKILL W. H., SHERLOCK S. Ammonium tolerance in liver disease: observations based on catheterization of the hepatic veins. J Clin Invest. 1955 Feb;34(2):158–168. doi: 10.1172/JCI103070. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. WRONG O., METCALFE-GIBSON A., MORRISON R. B., NG S. T., HOWARD A. V. IN VIVO DIALYSIS OF FAECES AS A METHOD OF STOOL ANALYSIS. I. TECHNIQUE AND RESULTS IN NORMAL SUBJECTS. Clin Sci. 1965 Apr;28:357–375. [PubMed] [Google Scholar]
  31. Walker J. G., Emlyn-Williams A., Rosenoer V. M., Craigie A., Agnew J. Treatment of chronic portal-systemic encephalopathy by surgical exclusion of the colon. Lancet. 1965 Oct 30;2(7418):861–866. doi: 10.1016/s0140-6736(65)92500-6. [DOI] [PubMed] [Google Scholar]
  32. Welbourne T. C. Mechanism of renal ammonia production adaptation to chronic acidosis. Med Clin North Am. 1975 May;59(3):629–648. doi: 10.1016/s0025-7125(16)32014-4. [DOI] [PubMed] [Google Scholar]
  33. Windmueller H. G., Spaeth A. E. Uptake and metabolism of plasma glutamine by the small intestine. J Biol Chem. 1974 Aug 25;249(16):5070–5079. [PubMed] [Google Scholar]
  34. Wolpert E., Phillips S. F., Summerskill W. H. Ammonia production in the human colon. Effects of cleansing, neomycin and acetohydroxamic acid. N Engl J Med. 1970 Jul 23;283(4):159–164. doi: 10.1056/NEJM197007232830401. [DOI] [PubMed] [Google Scholar]
  35. Zeegen R., Drinkwater J. E., Fenton J. C., Vince A., Dawson A. M. Some observations on the effects of treatment with lactulose on patients with chronic hepatic encephalopathy. Q J Med. 1970 Apr;39(154):245–263. [PubMed] [Google Scholar]

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