Peritoneal Dialysis in the Reduction of Blood Ammonia Levels in a Case of Hyperammonaemia

Four disease entities associated with hyper-ammonaemia and corresponding to lack of each of the specific enzymes required in the Krebs Henseleit urea cycle have now been reported (Russell et al., 1962; Freeman et al., 1964). A closely allied condition, lysine intolerance, where lysine competes with arginine for arginase has also recently been described (Colombo et al., 1964). Patients with these conditions have extremely high blood and CSF levels of ammonia, frequently much higher than in hepatic coma. The acute neurological sequence of spasticity, confusion, and coma during hyperammonaemic crises in these patients is analogous to that in hepatic coma precipitated by ingestion of protein in cirrhotic patients with an Eck fistula. Chronic ammonia intoxication, on the other hand, is characterized by periodic vomiting, deterioration of intelligence, progressive spasticity, and cerebral atrophy. Both haemodialysis and peritoneal dialysis have been shown to be of limited use in the treatment of ammonia intoxication in hepatic failure (Kile