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Journal of the American Society of Nephrology, Vol 5, 1066-1073, Copyright © 1994 by American Society of Nephrology

REGULAR ARTICLES

Unexpected encephalopathy in chronic renal failure: hyperammonemia complicating acute peritonitis

JL Pimentel Jr, SW Brusilow and WE Mitch
Renal Division, Emory University School of Medicine, Atlanta, GA 30322.

A woman with mild chronic renal insufficiency was being treated with glucocorticoids for a presumed chronic inflammatory disease. She developed peritonitis arising from a pelvic abscess, which was drained without complications. Unexpectedly, she became obtunded, and eventually, the neurologic dysfunction was linked to hyperammonemia in spite of normal liver function tests. Hyperammonemia was only transiently controlled in spite of protein restriction, repeated hemodialysis, and the use of biochemical means to reduce ammonia. A recurrent pelvic abscess was drained, and hyperammonemia disappeared. A review of ammonia and nitrogen metabolism indicates that bypassing the liver with shunting of ammonia into the systemic circulation should be added to the causes of symptomatic hyperammonemia. Treatment requires the elimination of the bacteria.


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 Nephrol Dial TransplantHome page
D. J. Hampel, J. Stoll, L. Nibbe, and M. Gollasch
Hyperammonaemic encephalopathy and severe metabolic acidosis in a patient with chronic renal insufficiency years after ureterosigmoidostomy
Nephrol. Dial. Transplant., September 1, 2007; 22(9): 2713 - 2719.
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Copyright © 2008 by the American Society of Nephrology. Online ISSN: 1533-3450 Print ISSN: 1046-6673