Transient Hyperammonemia Seen in Post Seizure Activity: A Series of Six Case Reports

Elevations in serum ammonia levels (i.e., hyperammonemia) have often been interpreted as signs of liver failure or errors in metabolism. The purpose of this series of case studies is to evaluate a trend in both the markedly elevated levels of ammonia, along with its rapid clearance in patients with seizures. These patient cases each occurred in a community-based, academic emergency department in the metropolitan Detroit area that provided care to approximately 70,000 patients during a four-year period. These six patient cases had each been found with observed seizure activity in which an initial and repeat ammonia in the emergency department was ordered. In all six cases, there was an initial elevation in ammonia with rapid subsequent clearance of ammonia. As demonstrated in this series of case studies, transient hyperammonemia levels may occur within the clinical context of seizure activity. With further research, it may be confirmed to be a differential diagnostic marker to delineate new onset or recurrent seizures in the ED.