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Related Experiment Video

Updated: Sep 14, 2025

Author Spotlight: Enhancing Cerebral Ischemia Research with a Simplified Rat Model
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A 91-Year-Old Female with Recurring Coma Due to Atypical Hyperammonemia.

Manuel Reichert1

  • 1Department of Internal Medicine II, City Hospital (Städtisches Klinikum), 38118 Braunschweig, Germany.

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|July 23, 2025
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Summary

This case study reveals non-hepatic hyperammonemia as an unusual cause of coma in the elderly. Prompt diagnosis and treatment with rifaximin and laxatives restored cognitive function.

Keywords:
comahyperammonemiametabolic encephalopathy

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Area of Science:

  • Neurology
  • Gastroenterology
  • Internal Medicine

Background:

  • Acute reduction in vigilance is a common emergency department admission, particularly in the elderly.
  • Intracranial causes and infections are frequent culprits, but diagnosis remains challenging in some cases.

Observation:

  • A 91-year-old woman presented with recurrent somnolence to coma, with normal initial CT and laboratory results.
  • Standard treatments for intoxication and Addison's crisis were ineffective.

Findings:

  • Elevated serum ammonia levels were identified as the cause of altered mental status.
  • Hyperammonemia was linked to abnormal intestinal bacterial colonization secondary to ureteroenterostomy, classifying it as non-hepatic.

Implications:

  • This case underscores the importance of considering rare metabolic disturbances, like non-hepatic hyperammonemia, in unexplained coma.
  • Broadening differential diagnoses in emergency settings is crucial for effective patient management.
  • Rifaximin and laxatives proved effective in treating this condition, normalizing ammonia levels and restoring cognitive function.