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A Comparison of the Fructose and Ammonia Tolerance Test in Cirrhosis.

Donald O. Castell, M.D. (Associate); Norman D. Grace, M.D.; Martin H. Wenner; and Thomas C. Chalmers, M.D., F.A.C.P.
Ann Intern Med. 1968;68(5):1146. doi:10.7326/0003-4819-68-5-1146_1
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The abnormal oral ammonia (NH3) tolerance test has been shown to correlate well with the presence of collateral circulation and portal hypertension in patients with cirrhosis. Like ammonium salts, ingested fructose is rapidly cleared from the portal blood by the liver, and elevated peripheral blood levels would be expected to occur with the development of portal systemic shunting. The usefulness of the NH3 tolerance test is limited by difficulties in laboratory determination, the necessity for arterial puncture, and potential hazard to the patients. The following data support the fructose tolerance test as a useful and practical substitute for the NH3


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