We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......

Treatment of Hepatic Failure and Coma

Henry Brown, MD
JAMA. 1967;201(7):547-548. doi:10.1001/jama.1967.03130070067022.
Text Size: A A A
Published online

The liver is the site where most of the important metabolic functions are carried out. Hepatic failure, therefore, involves almost every known synthesis and function. Clinically, it is characterized by jaundice, ascites, progressive emaciation, flap of hands, and physical weakness leading to ataxia and mental confusion. This is followed by stupor, deep coma, and finally death.

The rapidly expanding research into hepatic physiology has provided a basis for much of the modern treatment of hepatic failure. Biochemically, with involvement of most synthetic pathways, there is a deficit in protein synthesis characterized by anemia, reduced serum albumin, and reduced plasma clotting factors. The latter includes reduced fibrinogen and low prothrombin levels aggravated by poor vitamin K absorption. Serum globulins are first increased, then decreased. There is usually an increase in serum bilirubin from either obstruction of the biliary tree or inability to metabolize bilirubin breakdown products. Prolonged hyperglycemia is commonly observed


Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?




Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

0 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.