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Case Reports
. 2018 Mar 9:2018:bcr2017223245.
doi: 10.1136/bcr-2017-223245.

Multifactorial non-cirrhotic hyperammonaemic encephalopathy

Katherine Elizabeth Triplett  1 , Ronan Murray  2   3 , Matthew Anstey  1   4
Affiliations
Case Reports

Multifactorial non-cirrhotic hyperammonaemic encephalopathy

Katherine Elizabeth Triplett et al. BMJ Case Rep. .

Abstract

A 51-year-old female presented with acute confusion associated with a non-specific headache and lethargy. The patient's history included bipolar disorder on valproate and recent travel to northern Vietnam. The patient was subsequently found to have hyperammonaemia as well as a urinary tract infection and bacteraemia with Klebsiellapneumoniae The patient was presumed to have a multifactorial non-cirrhotic hyperammonaemic encephalopathy due to a combination of a urinary tract infection and bacteraemia with K. pneumoniae, a urease-producing bacteria, and also valproate use, a medication known to interfere with ammonia elimination. The patient's treatment included supportive care, ceasing valproate, empiric then rationalised antibiotics, N-acetylcysteine and L-carnitine. We present a case of non-cirrhotic hyperammonaemic encephalopathy and explain why it is multifactorial in origin.

Keywords: adult intensive care; neurology; unwanted effects / adverse reactions; urinary tract infections.

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Conflict of interest statement

Competing interests: None declared.

References

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