F. A. WALKER, M.D.
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To the editor: In the January 1973 issue (pp. 81-84) Kersh and Rifkin present a novel method of handling the problem of hyperammonemia, in their paper on lactulose enemas. However, an agent such as lactulose, with its high potential osmotic pressure in the bowel, is not without its own hazards.
As part of this same protocol sponsored by Phillips Roxanne Laboratories, we treated a patient who had propionic acidemia, with blood ammonia levels ranging from 400 to 1400 µg/ml on a diet of 0.8 to 1 mg protein per kg/body weight daily, on a double-blind basis with the solutions of
WALKER FA. Lactulose Enemas. Ann Intern Med. 1973;78:784–785. doi: https://doi.org/10.7326/0003-4819-78-5-784_3
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Published: Ann Intern Med. 1973;78(5):784-785.
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