Hyperammonemia in the ICU.
Patients experiencing acute elevations of ammonia present to the ICU with encephalopathy, which may progress quickly to cerebral herniation. Patient survival requires immediate treatment of intracerebral hypertension and the reduction of ammonia levels. When hyperammonemia is not thought to be the result of liver failure, treatment for an occult disorder of metabolism must begin prior to the confirmation of an etiology. This article reviews ammonia metabolism, the effects of ammonia on the brain, the causes of hyperammonemia, and the diagnosis of inborn errors of metabolism in adult patients.
Clay
Alison S
AS
Department of Surgery and Medicine, Duke University Medical Center, Box 2945, Durham, NC 27710, USA. alison.clay@duke.edu
Hainline
Bryan E
BE
D000208:Acute Disease; D000465:Algorithms; D000641:Ammonia / Q000097:blood / Q000378:metabolism; D001253:Astrocytes / Q000378:metabolism; D001921:Brain / Q000378:metabolism; D001929:Brain Edema; D002543:Cerebral Hemorrhage / Q000209:etiology / Q000378:metabolism; D003422:Critical Care; D005973:Glutamine / Q000378:metabolism; D006801:Humans; D022124:Hyperammonemia / Q000209:etiology / Q000378:metabolism / Q000628:therapy*; D007036:Hypothermia, Induced; D007362:Intensive Care Units; D008099:Liver / Q000378:metabolism; D017114:Liver Failure, Acute; D008111:Liver Function Tests; D008661:Metabolism, Inborn Errors / Q000150:complications / Q000378:metabolism; D018482:Muscle, Skeletal / Q000378:metabolism; D014508:Urea / Q000378:metabolism
D005973:Glutamine; D000641:Ammonia; D014508:Urea