Episodic Stupor Associated with an Eck Fistula in the Human with Particular Reference to the Metabolism of Ammoniaxs12

Abstract

The effect on animals of ligating the portal vein and diverting the blood from the portal system directly into the inferior vena cava through a surgically constructed fistula was first studied by Eck in 1877 (1).As a mark of respect for the ingenuity of these experiments, the eponym, "Eck fistula," has been perpetuated in medical writings.Animals so treated can be made to survive for long pe- riods of time in apparently good health and therefore the Eck fistula has been used extensively as a means of investigating the metabolic activities of the liver.Although dogs with an Eck fistula may remain in good clinical condition, it has been demonstrated that the liver undergoes a certain amount of atrophy; the production of plasma pro- teins, hemoglobin, and bile pigments is diminished; serum lipid levels are low despite adequate fat absorption; and the consumption and urinary output of water are increased (2-5).Perhaps the most interesting and controversial observation derived from these experiments has been the phenomenon of "meat intoxication," a neurological disorder consisting of stupor, ataxia, convulsions, and finally coma, which occurs in Eck fistula dogs either after the ingestion of meat, or spontaneously.This phenomenon has been studied extensively (6-10) and, while it has been suggested that vari- ous degradation products of protein metabolism are responsible, the pathogenesis actually remains obscure.Construction of an anastomosis between the portal vein and the inferior vena cava with or with- out interruption of the portal vein is frequently carried out in patients with portal hypertension for the treatment of esophageal varices.This anasto-