title: Unmasked adult-onset urea cycle disorders in the critical care setting.
abstract: Most often, urea cycle disorders have been described as acute onset hyperammonemia in the newborn period; however, there is a growing awareness that urea cycle disorders can present at almost any age, frequently in the critical care setting. This article presents three cases of adult-onset hyperammonemia caused by inherited defects in nitrogen processing in the urea cycle, and reviews the diagnosis, management, and pathophysiology of adult-onset urea cycle disorders. Individuals who have milder molecular urea cycle defects can lead a relatively normal life until a severe environmental stress triggers a hyperammonemic crisis. Comorbid conditions such as physical trauma often delay the diagnosis of the urea cycle defect. Prompt recognition and treatment are essential in determining the outcome of these patients.
authors.affiliation: Center for Human Genetic Research, Division of Medical Genetics, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN 37232-0165, USA. marshall.summar@vanderbilt.edu
authors.forename: Marshall L
authors.initials: ML
authors.lastname: Summar
authors.forename: Frederick
authors.initials: F
authors.lastname: Barr
authors.forename: Sheila
authors.initials: S
authors.lastname: Dawling
authors.forename: Wendy
authors.initials: W
authors.lastname: Smith
authors.forename: Brendan
authors.initials: B
authors.lastname: Lee
authors.forename: Rani H
authors.initials: RH
authors.lastname: Singh
authors.forename: William J
authors.initials: WJ
authors.lastname: Rhead
authors.forename: Lisa
authors.initials: L
authors.lastname: Sniderman King
authors.forename: Brian W
authors.initials: BW
authors.lastname: Christman
mesh_terms: D000328:Adult; D017668:Age of Onset; D020739:Brain Diseases, Metabolic, Inborn / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D020165:Carbamoyl-Phosphate Synthase I Deficiency Disease / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D016638:Critical Illness; D004630:Emergencies; D005260:Female; D006801:Humans; D022124:Hyperammonemia / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D020163:Ornithine Carbamoyltransferase Deficiency Disease / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D015985:Precipitating Factors; D014508:Urea / Q000378:metabolism*
chemical_list: D014508:Urea