Editorial

Hyperammonemic Coma: Beyond Hepatic Encephalopathy

Authors: Doron Rimar, MD, Haim Bitterman, MD

Abstract

Hyperammonemic coma (HAC) in adults is still perceived by many as synonymous with hepatic encephalopathy. Although this may be true in most cases, awareness of the differential diagnosis of the combination of impaired consciousness and hyperammonemia may disclose other potentially reversible states.


In this issue of the Southern Medical Journal, Chan et al1 present a case of HAC after chemotherapy for hepatic cell carcinoma (HCC). In their patient, a serum amino acids profile suggested ornithine transcarbamoylase (OTC) deficiency, and the patient responded to an infusion of arginine.

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References

1. Chan JS, Harding CO, Blanke CD. Post-chemotherapy hyperammonemic encephalopathy emulating ornithine transcarbamoylase (OTC) deficiency. South Med J In press.
 
2. Winter SS, Rose E, Katz R. Hyperammonemia after chemotherapy in an adolescent with hepatocellular carcinoma. J Pediatr Gastroenterol Nutr 1997;25:537–540.
 
3. Albrecht J, Norenberg MD. Glutamine: a Trojan horse in ammonia neurotoxicity. Hepatology 2006;44:788–794.
 
4. Rimar D, Kruzel-Davila E, Dori G, et al. Hyperammonemic coma—barking up the wrong tree. J Gen Intern Med 2007;22:549–552.
 
5. Nott L, Price TJ, Pittman K, et al. Hyperammonemia encephalopathy: an important cause of neurological deterioration following chemotherapy. Leukemia Lymphoma 2007;48:1702–1711.