title: Reversibility of serum NH3 level in a case of sudden onset and rapidly progressive case of type 2 citrullinemia.
abstract: A 48-year-old male presented with an acute change in mental status due to a marked elevation of plasma NH3 and was diagnosed with citrullinemia with amino acid analysis of blood. Hemodialysis and hemodiafiltration were performed, but serum chemical analysis did not show any improvement which led us to terminate dialysis following intensive care for 3 days. Surprisingly, NH3 level had decreased by 6 days after admission, coinciding with normalization of the size of the pupils. Since spontaneous remission had never been discussed, we discuss this relatively rare, but clinically significant entity with regard to its acute phase management and its potential reversibility.
authors.affiliation: Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka.
authors.forename: F
authors.initials: F
authors.lastname: Ishikawa
authors.forename: M
authors.initials: M
authors.lastname: Nakamuta
authors.forename: M
authors.initials: M
authors.lastname: Kato
authors.forename: H
authors.initials: H
authors.lastname: Iwamoto
authors.forename: M
authors.initials: M
authors.lastname: Enjoji
authors.forename: Y
authors.initials: Y
authors.lastname: Miyata
authors.forename: T
authors.initials: T
authors.lastname: Inoguchi
authors.forename: H
authors.initials: H
authors.lastname: Sakai
authors.forename: H
authors.initials: H
authors.lastname: Nawata
mesh_terms: D000641:Ammonia / Q000097:blood*; D020159:Citrullinemia / Q000097:blood* / Q000145:classification / Q000175:diagnosis; D018450:Disease Progression; D006801:Humans; D008297:Male; D008875:Middle Aged; D013997:Time Factors
chemical_list: D000641:Ammonia