Sir.—The prognosis of hepatic encephalopathy in general is extremely guarded. By using levodopa (100 mg/kg), 23 of 39 patients with hepatic encephalopathy related to different liver diseases responded to treatment, and 17 of them were discharged in an uncontrolled study.1 We administered naloxone (0.1 mg/kg intravenously) to eight patients with hepatic encephalopathy who did not respond to levodopa administration.
The ages of the patients ranged between 1.5 and 15 years (mean, 7.4 years; median, 7 years) and, with one exception, all were girls. With one exception (the youngest one with chronic hepatitis), all of the patients had fulminant hepatitis, which was also shown morphologically in three who died. Two of them had fulminant hepatitis 2.5 and four months after operations but hepatitis B surface antigen was found only in one. Alanine (150 to 1,330 units) and aspartate (125 to 980 units) aminotransferase levels, total (3.4 to 20.4 mg/dL)