2023
DOI: 10.1097/mco.0000000000000899
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Ammonia and nutritional therapy in the critically ill: when to worry, when to test and how to treat?

Abstract: Purpose of reviewHyperammonaemia is almost always develops in patients with severe liver failure and this remains the commonest cause of elevated ammonia concentrations in the ICU. Nonhepatic hyperammonaemia in ICU presents diagnostic and management challenges for treating clinicians. Nutritional and metabolic factors play an important role in the cause and management of these complex disorders.Recent findingsNonhepatic hyperammonaemia causes such as drugs, infection and inborn errors of metabolism may be unfa… Show more

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Cited by 3 publications
(25 citation statements)
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“…We recently read a comprehensive review by Chang et al (1) on acute adult disorders of consciousness (DoC) for intensivists, but we noticed that a crucial cause of DoC was not mentioned. Severe liver failure is a common cause of hyperammonemia in ICU patients and requires urgent treatment to avoid neurologic complications and even death (2). However, nonhepatic hyperammonemia in ICU patients can pose diagnostic and management challenges for clinicians (2–4).…”
Section: To the Editormentioning
confidence: 99%
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“…We recently read a comprehensive review by Chang et al (1) on acute adult disorders of consciousness (DoC) for intensivists, but we noticed that a crucial cause of DoC was not mentioned. Severe liver failure is a common cause of hyperammonemia in ICU patients and requires urgent treatment to avoid neurologic complications and even death (2). However, nonhepatic hyperammonemia in ICU patients can pose diagnostic and management challenges for clinicians (2–4).…”
Section: To the Editormentioning
confidence: 99%
“…Although diffusive therapies may have some theoretical advantages, there is no clear evidence that any particular modality is superior. Peritoneal dialysis and exchange transfusion have both been DoC as inferior treatment strategies and the role of more complex blood purification methods is still unclear (2–4). Conventional hemodialysis can rapidly reduce ammonia concentrations.…”
Section: To the Editormentioning
confidence: 99%
See 3 more Smart Citations