title: [Hyperammonemic encephalopathy in multiple myeloma].
abstract: METHODS
  A 54-year old man had suffered from advanced multiple myeloma for two years. After initially good response the myeloma was refractrory to treatment with dexamethasone, cyclophosphamide, bortezomibe, zoledronate and additionally doxorubicine. The patient then complained of dyspnea without clinical signs of cardiopulmonary disease.
  
  
  METHODS
  Arterial blood gas analysis showed hyperventilation with respiratory alkalosis and normal alveolo-arterial gradient as the reason for the dyspnea. With a normal MRI of the brain and lumbal puncture, a neurological disease could be excluded. Serum calcium, creatinine and serum viscosity were normal. Eventually, serum ammonia levels were found to be substantially elevated (144 µmol/l) and hyperammonemic encephalopathy was diagnosed.
  
  
  METHODS
  Therapy with bortezomib and high dose dexamethason was repeated, and the patient also received bendamustin. Despite this treatment, he lost consciousness and died after two weeks because of aspiration pneumonia.
  
  
  CONCLUSIONS
  The existence of respiratory alkalosis and multiple myeloma should prompt a search for hyperammonemia.
authors: Universitätsklinik für Allgemeine Innere Medizin, Inselspital, Universitätsspital Bern, Schweiz.
authors: A
authors: A
authors: Oestmann
authors: Universitätsklinik für Allgemeine Innere Medizin, Inselspital, Universitätsspital Bern, Schweiz.
authors: D
authors: D
authors: Aujesky
mesh_terms: D000472:Alkalosis, Respiratory / Q000175:diagnosis / Q000188:drug therapy; D000641:Ammonia / Q000097:blood; D000069461:Bendamustine Hydrochloride; D001897:Boronic Acids / Q000627:therapeutic use; D000069286:Bortezomib; D003907:Dexamethasone / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D004417:Dyspnea / Q000188:drug therapy / Q000209:etiology; D017809:Fatal Outcome; D006801:Humans; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000175:diagnosis* / Q000188:drug therapy; D009588:Nitrogen Mustard Compounds / Q000627:therapeutic use; D011719:Pyrazines / Q000627:therapeutic use; D015518:Rett Syndrome / Q000175:diagnosis* / Q000188:drug therapy
chemical_list: D001897:Boronic Acids; D009588:Nitrogen Mustard Compounds; D011719:Pyrazines; D000069286:Bortezomib; D000641:Ammonia; D003907:Dexamethasone; D000069461:Bendamustine Hydrochloride