Hiperamonemia sin falla hepática en la Unidad de Cuidados Intensivos

Abstract

We present the case of an 82-year-old woman with a prolonged hospital stay due to multiple complications secondary to major bile duct surgery for gallbladder carcinoma plus radical cholecystectomy plus trisegmental hepatectomy, she presented chronic diarrhea (3 months of evolution), accompanied by an episode of altered state of consciousness and convulsive episodes, with changes in ammonium levels (333 mmol/L) without changes in liver function.

Carnitine deficiency secondary to chronic diarrhea was considered the cause of hyperammonemia, and treatment was started, which consisted of extended hemodialysis-type renal replacement therapy, given the limitation for starting treatment with ammonium binders due to persistent diarrhea, just as it was started. loperamide, evidencing improvement in the state of consciousness and decrease in ammonium levels 133 mmol/L.

Multiple clinical situations can cause decompensation with hyperammonemia in a patient, being fatal, causing permanent or irreversible neurological damage. Hyperammonemia may be one of the neglected causes as encephalopathy in patients admitted to the intensive care unit, caused by a constellation of conditions, including medications, infections, liver compromise, parenteral nutrition, and many other causes. being overlooked, due to its scarce investigation.

The knowledge that allows an adequate and timely diagnosis, with the aim of reducing clinical decompensation and correct management in the acute phase, is essential to minimize fatal consequences.