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Simultaneous double hemodialysis for the control of refractory hyperammonemia
Michael Brucculeri1, Wesley Gabbard, John Masson
1Renal Hypertension Center, Hudson, FL, USA. mjb69@columbia.edu
The International Journal of Artificial Organs
|February 14, 2013
Summary
Severe hyperammonemia in a multiple myeloma patient refractory to standard treatments was successfully managed with simultaneous hemodialysis. This approach, combined with chemotherapy, resolved the encephalopathy and allowed for discharge.
Area of Science:
- Nephrology
- Oncology
- Neurology
Background:
- Hyperammonemia in adults typically stems from liver dysfunction or complications of urinary diversions.
- Rarely, hyperammonemia is associated with multiple myeloma and can cause severe encephalopathy, cerebral edema, and death.
Observation:
- A 72-year-old male with end-stage renal disease and multiple myeloma presented with severe hyperammonemia and profound encephalopathy.
- The patient's hyperammonemia was refractory to medical therapies, including cathartics, antibiotics, and various forms of hemodialysis (high-flux, CVVHD).
Findings:
- Simultaneous continuous venovenous hemodialysis (CVVHD) and extended daily hemodialysis (EDD) effectively reversed the hyperammonemia and encephalopathy.
- Subsequent administration of vincristine and dexamethasone led to a durable response, enabling a return to intermittent hemodialysis (IHD).
Implications:
- Simultaneous double hemodialysis is a valuable adjunct for refractory hyperammonemia, particularly in patients with multiple myeloma.
- This case highlights the importance of considering novel dialysis strategies and chemotherapy in managing complex metabolic derangements associated with hematologic malignancies.
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