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Recurrent Hyperammonemia During Enteral Tube Feeding for Severe Protein Malnutrition After Bariatric Surgery
Louise Hendrikx1, Hans Brandts2, Marcel van Borren3
1Departments of Internal Medicine, Rijnstate Hospital, Wagnerlaan 55, 6800, TA, Arnhem, The Netherlands. louisehendrikx@home.nl.
Abstract:
A 28-year-old female was admitted 2 years after gastric bypass limb distalization because of severe weight loss, fatigue, chronic diarrhea, massive edema, and a serum albumin of 10 g/L without proteinuria. A diagnosis of severe energy and protein malnutrition was made, and enteral tube feeding was started in combination with pancreatic enzyme supplementation every 3 h. Within 24 h after the start of tube feeding, she developed severe hyperammonemia. Tube feeding was stopped immediately, and this led to a normalization of serum ammonia levels within 8 h. When tube feeding was resumed, albeit at a lower rate and with preventive measures taken, hyperammonemia occurred again. The underlying causes and treatments of hyperammonemia during tube feeding are discussed.
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