Sudden severe hyperammonemia and status epilepticus -a case report-
Woo-Kyung Shin1, Young-Eun Jang, Hannah Lee
1Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea.
Korean Journal of Anesthesiology
|October 9, 2013
Summary
Severe hyperammonemia caused a sudden decline in consciousness and seizures in a septic shock patient. Despite treatment, high ammonia levels led to cerebral edema and death, highlighting a critical complication in intensive care units.
Area of Science:
- Critical Care Medicine
- Neurology
- Nephrology
Background:
- Altered consciousness in intensive care units (ICUs) can stem from neurological injury, infection, or metabolic issues.
- A patient with septic shock post-colon perforation surgery developed a sudden decline in consciousness and seizures.
Purpose of the Study:
- To investigate the cause of altered consciousness and seizures in a critically ill patient with septic shock.
Main Methods:
- Case report of a 39-year-old female patient.
- Monitoring of neurological status, laboratory values (including ammonia levels), and neuroimaging (Brain CT).
- Intervention with continuous renal replacement therapy (CRRT).
Main Results:
- The patient presented with severe hyperammonemia concurrent with generalized seizures and rapid neurological deterioration.
- Brain CT revealed new-onset severe cerebral edema.
- CRRT was ineffective in reducing serum ammonia levels.
Conclusions:
- Severe hyperammonemia can precipitate rapid neurological decline, seizures, and cerebral edema in critically ill patients.
- This complication may be refractory to standard treatments like CRRT.
- Highlights the importance of monitoring ammonia levels in ICU patients with altered consciousness.
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