Ammonium Tolerance in Liver Disease: Observations Based on Catheterization of the Hepatic Veins

The concept that substances from intestinal con- tents, passing into the general circulation, may cause toxic symptoms has been of particular in- terest in the study of liver disease. In 1896, Nencki, Pawlow, and Zaleski (1) demonstrated that diversion of portal blood, containing large amounts of ammonium, into the general circulation by an Eck fistula resulted in an increase in am- monium content of peripheral blood. In cirrhosis of the liver and in patients with porta-caval anasto- moses elevation of blood ammonium has frequently been found and in some cases correlated with neurological disturbances (2-10).