Ammonium Chloride Therapy in Liver Disease

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To the editor: 1 read with great interest the article in the November issue entitled “Life-Threatening Hyperkalemia Induced by Arginine” by Bushinsky and Gennari (1). In the article one of the named contraindications to the use of arginine was the presence of liver disease. A listed alternative therapy to arginine for metabolic alkalosis, presumably in patients with liver disease, was the infusion of ammonium chloride. A 1943 reference was cited. The role of ammonia intoxification in the genesis of hepatic encephalopathy was developing in 1955 (2). After the finding of this relationship, ammonium chloride by mouth or by infusion was

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