title: Coma query cause.
abstract: A 54-year-old woman with coeliac disease was admitted to hospital electively for supplemental nutrition. Shortly after feeding started she deteriorated into a hyperammonemic coma with refeeding syndrome, requiring an extensive intensive care admission. Urea cycle disorders were investigated and a biochemical diagnosis of ornithine transcarbamylase deficiency was made. This is a rare diagnosis in the adult population. This case report summarises protein metabolism, urea cycle disorders and the challenges of management.
authors.affiliation: Intensive Care Unit, Queen Alexandra Hospital, Portsmouth, Hampshire, UK.
authors.forename: Georgina Elizabeth
authors.initials: GE
authors.lastname: Wood
authors.affiliation: Intensive Care Unit, Queen Alexandra Hospital, Portsmouth, Hampshire, UK.
authors.forename: James
authors.initials: J
authors.lastname: McNicholas
mesh_terms: D003128:Coma / Q000097:blood / Q000209:etiology*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D022124:Hyperammonemia / Q000097:blood / Q000150:complications / Q000209:etiology*; D008875:Middle Aged; D020163:Ornithine Carbamoyltransferase Deficiency Disease / Q000097:blood / Q000150:complications* / Q000175:diagnosis* / Q000628:therapy