Zimmerman HJ (1986) Effects of alcohol on other hepatotoxins.

Liver biopsies show extensive centrilobular hepatic necrosis with little inflammatory reaction.

At this time there was no increase in hepatic fat.

Pretreatment with piperonyl butoxide or cobaltous chloride, which inhibit hepatic microsomal function, protects against paracetamol- induced hepatotoxicity in animals.

Endogenous hyperammonaemia Inborn errors of metabolism Hepatic features

2.9.1 Methionine in patients with hepatic dysfunction Phear et al.

Clark R, Thompson RPH, Borirakchanyavat V, Widdop B, Davidson AR, Goulding R, & Williams R (1973b) Hepatic damage and death from overdose of paracetamol.

Boyer TD & Rouff SC (1971) Acetaminophen induced hepatic necrosis and renal failure.

(1991) performed an open randomized study of 50 consecutive patients with paracetamol-induced fulminant hepatic failure without previous N-acetylcysteine treatment.

Thomas CE & Reed DJ (1988) Effect of extracellular Ca++ omission on isolated hepatocytes.

Plants use ammonia as a nutrient, but high levels can be toxic.

Urban and industrial atmospheric levels of ammonia in a few global locationsa--------------------------------------------------------------------Location Year Concentration Reference (µg/m3)-------------------------------------------------------------------- Germany, Federal Republic of Frankfurt-am-Main pre-1963 8 - 20 Georgii (1963) Italy Cagliari - 37 - 280 Spinazzola et (highest conc.

(1956) Cerebral metabolism in hepatic insufficiency.

In domestic tap water from Michigan wells averaging 20 m in depth, mean levels of ammonia-nitrogen were between 0.04 and 0.18 mg/litre; the highest reported single value was 0.57 mg/litre from a well 12.5 m in depth (Rajagopal, 1978).

A possible role for mercaptans in the pathogenesis of hepatic coma.

In rats fed a low protein diet, the rate of decline of hepatic methionine was slower, so that the 3 h level was 700% of control (Finkelstein et al., 1982).

Treatment of Hepatic Encephalopathy — NEJM

Analysis of data from the Water Quality Control Information (STORET) System for the years 1972 - 77 (US EPA, 1979a) showed that, although total ammonia-nitrogen concentrations in surface waters in the USA tended to be slightly lower during summer months than during winter months, the percentage of areas in which non-ionized ammonia concentrations occasionally exceeded 0.02 mg/litre increased from 11% during winter to 23% during summer; these percentages were higher when waters had elevated pH values.

Rifaximin Treatment in Hepatic Encephalopathy — NEJM

They had severe hypoglycaemia (blood sugar averaged 207 mg/l compared with 1295 mg/l in controls) with significantly depressed hepatic glycogen stores and generalised aminoacidaemia.

MR Imaging Findings in Hepatic Encephalopathy | …

Atmospheric ammonia levels also show a seasonal variation, the highest levels being attained during the winter and the lowest during the summer months.