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Hyperammonaemic encephalopathy following an uncomplicated surgery
Stuart McIntosh1, Karima Medjoub1, Kevin Deans2
1Plastic Surgery Department, NHS Grampian, Aberdeen, UK.
BMJ Case Reports
|August 18, 2017
Summary
A surgical patient developed hyperammonaemic encephalopathy due to low arginine levels. Prompt treatment with arginine and other therapies rapidly improved her neurological status and ammonia levels.
Area of Science:
- Medicine
- Biochemistry
- Surgery
Background:
- Postoperative complications can be complex and multifactorial.
- Nutritional status significantly impacts recovery after major surgery.
Observation:
- A 59-year-old woman experienced wound dehiscence and poor nutrition post-surgery.
- She developed severe neurological decline with tremor and weakness, indicated by a Glasgow Coma Scale (GCS) of 4.
Findings:
- Investigations revealed hyperammonaemic encephalopathy, linked to low arginine and possible small intestinal bacterial overgrowth.
- Treatment involved arginine supplementation, sodium benzoate, sodium phenylbutyrate, hemodialysis, and rifaximin.
Implications:
- This case highlights the importance of considering metabolic encephalopathy in postoperative patients with neurological decline.
- Arginine supplementation and addressing underlying causes like bacterial overgrowth are crucial for managing hyperammonaemic encephalopathy.
- Multidisciplinary care is essential for optimizing outcomes in complex surgical patients.
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