Hyperammonemia in the ICU

Clay, Alison S.; Hainline, Bryan E.

doi:10.1378/chest.06-2940

Cited by 171 publications

(193 citation statements)

References 138 publications

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confidence: 99%

“…1 Prolonged hyperammonemia can lead to significant brain injury and long-term sequelae, such as intellectual impairment. 1,2 Prompt recognition and treatment of hyperammonemia is, therefore, essential to avoid complications such as cerebral edema and brain herniation, which can prove fatal. 2 In the pediatric population, acute hyperammonemic encephalopathy and its imaging findings have been well described as a result of inborn errors of metabolism (eg, urea cycle disorders or organic acidemias).…”

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confidence: 99%

“…Acute hepatic dysfunction is most frequently implicated, but other etiologies include portosystemic shunt surgery, drugs (eg, sodium valproate, asparaginase therapy, or chemotherapy), infections, hypothyroidism, multiple myeloma, and post-lung or bone marrow transplantation. 1,2,[5][6][7][8][9] The radiologic findings of acute hyperammonemic encephalopathy are less well recognized in the adult literature, yet imaging may yield clues to the underlying diagnosis. The purpose of this study was to describe the MR imaging features of adult hyperammonemic encephalopathy.…”

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confidence: 99%

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Acute Hyperammonemic Encephalopathy in Adults: Imaging Findings

U-King-Im¹,

Yu²,

Bartlett³

et al. 2010

AJNR Am J Neuroradiol

103

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Acute Hyperammonemic Encephalopathy in Adults: Imaging Findings

U-King-Im¹,

Yu²,

Bartlett³

et al. 2010

AJNR Am J Neuroradiol

103

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“…The causes of hyperammonemia, other than liver diseases, are not common but some reports exist [1][2][3][4] . In our patient, hyperammonemia was principally induced by production of ammonia in the urine with urease-producing bacteria.…”

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confidence: 99%

A case of hyperammonemia due to urinary tract infection complicated by hypothyroidism

Inoue

Nakada

Namiki

et al. 2012

Nihon Kyukyu Igakukai Zasshi

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An 84-year-old woman was transferred to our emergency department because of disturbance of consciousness by an ambulance. She was treated for Graves disease in her 20's, but the treatment has been discontinued. She regularly visited a family doctor for hypertension, hyperlipidemia, gastroesophageal reflux, and osteoporosis. Her regularly medications were: lansoprazole, metoclopramide, ethyl icosapentate, rosuvastatin calcium, mosapride citrate hydrate, magnesium hydroxide, alfacalcidol, risedronate sodium hydrate, meloxicam. One day before she came to our hospital, the patient visited her family doctor with complaining of lower abdominal pain, general fatigue, and low motivation. She received intravenous fluid for dehydration and was prescribed ciprofloxacin hydrochloride for diagnosis as cystitis. As she expressed suicidal ideation, sulpiride was administered for depression as well. On the following day, when the acquaintance visited the patient at home, the patient was A case of hyperammonemia due to urinary tract infection complicated by hypothyroidismHiroyuki Inoue 1 , Takuro Nakada 1 , Mizuho Namiki 2 , Arino Yaguchi 2 ABSTRACT We report a case of disturbance of consciousness due to hyperammonemia stemming from urinary tract infection with urease-producing bacteria and complicated with hypothyroidism. An 84-yearold woman visited her family doctor with a history of excessive fatigue and was prescribed ciprofloxacin hydrochloride for cystitis and sulpiride for depression. The following day, she was brought to our hospital in an ambulance because of disturbance of consciousness. Sulpiride poisoning was suspected, and she was admitted to our emergency department. Because blood tests suggested hyperammonemia (197 µg/dl) and hypothyroidism, she was administered Lactulose, branched-chain amino acids, and thyroid hormones. Neither liver disease nor portosystemic shunting was observed in the blood or the imaging tests. The consciousness level initially improved along with the ammonia levels, however it later deteriorated again as the ammonia levels increased. Because urinary tract infection was complicated, we started administering antimicrobials. As a result, the level of ammonia normalized, and the level of consciousness improved. Arthrobacter cumminsii was detected by urine culture. Thus, we made a diagnosis as hyperammonemia due to urinary tract infection with urease-producing bacteria. In addition, hypothyroidisim in the patient aggravated hyperammonemia. In cases of hyperammonemia unaccompanied by liver disease, urease-producing bacterial infection and/or hypothyroidism should be considered. (JJAAM. 2012; 23: 398-402)

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“…Hyperammonemia can occur in critically ill patients, especially in those suffering from decompensated liver cirrhosis, acute liver failure or receiving certain drugs, such as valproic acid [1]. If untreated, elevated NH 4 levels may progressively cause brain edema and subsequent herniation.…”

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confidence: 99%