title: A patient with hemodialysis-related hyperammonemic encephalopathy: a delayed presentation of congenital arterioportal fistulas.
abstract: We present a 32-year-old woman who developed hyperammonemic encephalopathy during hemodialysis. She was rather well before 2009 when receiving peritoneal dialysis due to chronic interstitial nephritis. Due to a refractory peritonitis, the treatment was shifted to hemodialysis in January 2009. About 1 year later, she was found with consciousness disturbance during hemodialysis then admitted to the hospital because of hyperammonemia (165 μg/dl). During hospitalization, the patient's abdominal Doppler sonography showed a hepatofugal flow in the portal trunk while the hepatic artery angiography demonstrated multiple intrahepatic arterioportal fistulas. Her general condition was improved after the treatment of lactulose and hepatic artery embolization. With the occurrence of arterioportal fistulas induced portal hypertension, we speculated that the portal-systemic shunt was enhanced during hemodialysis because of venous hypotension which then resulted in the transient hyperammonemia. To the best of our knowledge, this is the first patient who developed hemodialysis- related hyperammonemic encephalopathy due to multiple arterioportal fistulas.
authors.affiliation: Division of Nephrology, Department of Medicine, Department of Radiology, Division of Gastroenterology, Department of Medicine, Taipei , Taiwan.
authors.forename: Shang-Feng
authors.initials: SF
authors.lastname: Yang
authors.forename: Hsiou-Shan
authors.initials: HS
authors.lastname: Tseng
authors.forename: Hui-Chun
authors.initials: HC
authors.lastname: Huang
authors.forename: I-Fang
authors.initials: IF
authors.lastname: Hsin
authors.forename: Yen-Hung
authors.initials: YH
authors.lastname: Yao
authors.forename: Jinn-Yang
authors.initials: JY
authors.lastname: Chen
mesh_terms: D000328:Adult; D001164:Arteriovenous Fistula / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D002908:Chronic Disease; D004621:Embolization, Therapeutic; D005260:Female; D005765:Gastrointestinal Agents / Q000627:therapeutic use; D006499:Hepatic Artery / Q000002:abnormalities*; D006501:Hepatic Encephalopathy / Q000209:etiology* / Q000628:therapy; D006801:Humans; D022124:Hyperammonemia / Q000150:complications* / Q000209:etiology / Q000628:therapy; D033162:Incidental Findings; D007792:Lactulose / Q000627:therapeutic use; D009395:Nephritis, Interstitial / Q000150:complications / Q000628:therapy; D011169:Portal Vein / Q000002:abnormalities*; D006435:Renal Dialysis / Q000009:adverse effects*; D016896:Treatment Outcome
chemical_list: D005765:Gastrointestinal Agents; D007792:Lactulose