Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
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.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Venkatesan A, Tunkel AR, Bloch KC, et al. . Case definitions, diagnostic algorithms, and priorities in encephalitis: consensus statement of the international encephalitis consortium. Clin Infect Dis 2013;57:1114–28. 10.1093/cid/cit458 - DOI - PMC - PubMed
    1. Prado FA, Delfino VD, Grion CM, et al. . Hyperammonemia in ICU patients: a frequent finding associated with high mortality. J Hepatol 2015;62:1216–8. 10.1016/j.jhep.2015.01.009 - DOI - PubMed
    1. Oja SS, Saransaari P, Korpi ER. Neurotoxicity of Ammonia. Neurochem Res 2017;42:713–20. 10.1007/s11064-016-2014-x - DOI - PubMed
    1. Laish I, Ben Ari Z. Noncirrhotic hyperammonaemic encephalopathy. Liver Int 2011;31:1259–70. 10.1111/j.1478-3231.2011.02550.x - DOI - PubMed
    1. Upadhyay R, Bleck TP, Busl KM. Hyperammonemia: What Urea-lly Need to Know: Case Report of Severe Noncirrhotic Hyperammonemic Encephalopathy and Review of the Literature. Case Rep Med 2016;2016:1–10. 10.1155/2016/8512721 - DOI - PMC - PubMed

Publication types

MeSH terms