title: [Efficacy of various therapeutic measures in metabolic hyperammonemia].
abstract: OBJECTIVE
  The aims of this work were to describe the therapeutic options available for severe hyperammonemia in children when ammonium levels are so high that the child's neurologic future or even their life is compromised. In addition, a comparison of the relative efficacy of each therapeutic method is made.
  
  
  METHODS
  We present six cases, five of which suffered from inborn errors of metabolism and a six which presented with Reye's syndrome, all of whom presented or developed hyperammonemic coma. Their initial ammonium levels fluctuated between 300 and more than 2000 micrograms per deciliter. The treatment was made with exchange transfusion (ET), ET and peritoneal dialysis (DP) together or hemodialysis (HD).
  
  
  RESULTS
  Peritoneal dialysis was the method that obtained the greatest reduction in plasma ammonium levels. However, the quickest reduction was observed with ET and HD. There were no significant complications with any of the methods except for hemodynamic deterioration in one patient during HD.
  
  
  CONCLUSIONS
  We believe that HD is the treatment of choice for these patients because it is able to obtain a quick and lasting clearance of plasma ammonium. However, this method is not always available and has not been used very often in small babies. In these cases, the combined use of ET and DP can be very useful.
authors.affiliation: Servicio de Pediatría, Hospital Ramón y Cajal, Madrid.
authors.forename: M J
authors.initials: MJ
authors.lastname: Pérez Rodríguez
authors.forename: J L
authors.initials: JL
authors.lastname: Vázquez Martínez
authors.forename: M
authors.initials: M
authors.lastname: Martínez-Pardo Casanova
authors.forename: I
authors.initials: I
authors.lastname: Martos Sánchez
authors.forename: C
authors.initials: C
authors.lastname: Lozano Jiménez
authors.forename: N
authors.initials: N
authors.lastname: Gallego Cobos
mesh_terms: D000641:Ammonia / Q000378:metabolism*; D002648:Child; D002675:Child, Preschool; D005078:Exchange Transfusion, Whole Blood; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008661:Metabolism, Inborn Errors / Q000628:therapy*; D010530:Peritoneal Dialysis; D006435:Renal Dialysis
chemical_list: D000641:Ammonia