{"title":"Unmasking Hyperammonemia: Psychomotor Slowing as a Diagnostic Trigger During PEG and Enteral Nutrition.","authors":"Xiaoyi Zhao, Yue Shen, Qiang Zhan","doi":"10.1177/00031348261460479","DOIUrl":null,"url":null,"abstract":"<p><p>A 63-year-old woman developed severe hyperammonemia and psychomotor slowing following percutaneous endoscopic gastrostomy (PEG) and continuous enteral nutrition (EEN) for anxiety-related feeding difficulties. Despite normal neuroimaging, her plasma ammonia levels peaked at 117.6 μmol/L. Immediate management via PEG removal and transition to a semi-liquid oral diet successfully normalized ammonia levels and restored cognitive function. This case highlights that PEG-associated EEN, potentially combined with specific formula deficiencies or metabolic vulnerabilities, can precipitate hyperammonemia. Surgeons and gastroenterologists should recognize unexplained psychomotor slowing as a critical diagnostic trigger for hyperammonemia in patients on long-term enteral feeding to ensure prompt intervention.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"2646-2647"},"PeriodicalIF":1.0000,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"American Surgeon","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1177/00031348261460479","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2026/6/9 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"SURGERY","Score":null,"Total":0}
引用次数: 0
Abstract
A 63-year-old woman developed severe hyperammonemia and psychomotor slowing following percutaneous endoscopic gastrostomy (PEG) and continuous enteral nutrition (EEN) for anxiety-related feeding difficulties. Despite normal neuroimaging, her plasma ammonia levels peaked at 117.6 μmol/L. Immediate management via PEG removal and transition to a semi-liquid oral diet successfully normalized ammonia levels and restored cognitive function. This case highlights that PEG-associated EEN, potentially combined with specific formula deficiencies or metabolic vulnerabilities, can precipitate hyperammonemia. Surgeons and gastroenterologists should recognize unexplained psychomotor slowing as a critical diagnostic trigger for hyperammonemia in patients on long-term enteral feeding to ensure prompt intervention.
期刊介绍：
The American Surgeon is a monthly peer-reviewed publication published by the Southeastern Surgical Congress. Its area of concentration is clinical general surgery, as defined by the content areas of the American Board of Surgery: alimentary tract (including bariatric surgery), abdomen and its contents, breast, skin and soft tissue, endocrine system, solid organ transplantation, pediatric surgery, surgical critical care, surgical oncology (including head and neck surgery), trauma and emergency surgery, and vascular surgery.
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