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[A rare cause of hepatic coma].
M U Adamek1, H Brass, U Karbach
1Innere Abteilung, Vinzentius-Krankenhaus Landau/Pfalz. u.karbach@sprsuew.ron.de
Medizinische Klinik (Munich, Germany : 1983)
|May 24, 2001
Summary
This case highlights bacterial overgrowth in the colon causing hyperammonemia and hepatic encephalopathy. Antibiotic treatment was considered to reduce ammonia production in this rare condition.
Area of Science:
- Nephrology
- Gastroenterology
- Hepatology
Background:
- A 65-year-old female presented with somnolence, hypertension, and a positive Babinski's sign.
- Past surgical history included ureterosigmoidostomy, cystectomy, and nephrectomy.
Observation:
- Laboratory results revealed elevated liver enzymes, metabolic alkalosis, and renal function impairment.
- The patient progressed to hepatic coma with ammonia levels exceeding 400 µg/dL.
Findings:
- The hepatic encephalopathy stemmed from bacterio-genic ureapoiesis and bacterial overgrowth in the operated colon, leading to hyperammonemia.
- Mild alcoholic liver disease impaired ammonia metabolism to urea, exacerbating hyperammonemia.
Implications:
- This case illustrates an unusual cause of hepatic encephalopathy originating from the gastrointestinal tract.
- Management strategies may involve reducing bacterial load in the colon with antibiotics to mitigate ammonia formation and prevent encephalopathy.