title: Two Cases of Hemodialysis-associated Chronic Portal-systemic Shunt Encephalopathy (CPSE) with Opposite Changes in the Blood Ammonia Concentrations during Hemodialysis: A Case Report and Literature Review.
abstract: The onset of hyperammonemia due to the flow of ammonia-rich portal vein blood through a portal-systemic shunt causes a type of encephalopathy known as chronic portal-systemic shunt encephalopathy (CPSE). We herein report two cases of CPSE that presented with opposite changes in the blood ammonia concentrations during hemodialysis. It is curious that the encephalopathy was ameliorated by hemodialysis in case 1, but not case 2. Therefore, it is necessary to recognize CPSE and assess the blood ammonia concentrations in dialysis patients who develop a disturbance of consciousness, even if the serum transaminase level is normal.
authors.affiliation: Department of Nephrology, Tokyo Medical and Dental University, Japan.
authors.forename: Katsuyuki
authors.initials: K
authors.lastname: Oi
authors.forename: Tomokazu
authors.initials: T
authors.lastname: Okado
authors.forename: Hisako
authors.initials: H
authors.lastname: Togo
authors.forename: Soichiro
authors.initials: S
authors.lastname: Iimori
authors.forename: Naofumi
authors.initials: N
authors.lastname: Yui
authors.forename: Eisei
authors.initials: E
authors.lastname: Sohara
authors.forename: Eiichiro
authors.initials: E
authors.lastname: Kanda
authors.forename: Tatemitsu
authors.initials: T
authors.lastname: Rai
authors.forename: Sei
authors.initials: S
authors.lastname: Sasaki
authors.forename: Shinichi
authors.initials: S
authors.lastname: Uchida
mesh_terms: D000368:Aged; D000641:Ammonia / Q000097:blood*; D001925:Brain Damage, Chronic / Q000097:blood* / Q000209:etiology* / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011169:Portal Vein; D006435:Renal Dialysis / Q000009:adverse effects*; D016896:Treatment Outcome
chemical_list: D000641:Ammonia