title: Hyperammonemia in Urinary Tract Infections.
abstract: OBJECTIVE
  The present study investigated the incidence of hyperammonemia in urinary tract infections and explored the utility of urinary obstruction relief and antimicrobial administration to improve hyperammonemia.
  
  
  METHODS
  This was an observational study. Subjects were patients who were diagnosed with urinary tract infection and hospitalized between June 2008 and June 2009. We measured plasma ammonia levels on admission in patients who were clinically diagnosed with urinary tract infection and hospitalized. We assessed each patient's level of consciousness on admission using the Glasgow Coma Scale (GCS) and performed urine and blood cultures. We also assessed hearing prior to hospitalization using the Eastern Cooperative Oncology Group performance status (ECOG-PS). In cases with high ammonia levels on admission, plasma ammonia and GCS were measured 24 hours and 5-7 days later.
  
  
  RESULTS
  Sixty-seven candidates were enrolled; of these, 60 cases (89.6%) with bacterial cell counts ≥10(4) CFU/mL were studied. Five cases (8.3%) presented with high plasma ammonia levels. Cases with hyperammonemia were significantly more likely to present with low GCS scores and urinary retention rate. All five cases received antimicrobial therapy with an indwelling bladder catheter to relieve urinary retention. The case 5 patient died shortly after admission due to complicated aspiration pneumonia; in the remaining cases, plasma ammonia levels were rapidly normalized and the level of consciousness improved.
  
  
  CONCLUSIONS
  The occurrence of hyperammonemia in urinary tract infections is not rare. The cause of hyperammonemia is urinary retention obstruction. Therefore, along with antimicrobial administration, relief of obstruction is important for the treatment of hyperammonemia caused by this mechanism.
authors: Division of General Medicine, Center for Community Medicine, Jichi Medical University School of Medicine, Shimotsuke, Japan; Division of Community Medicine and Career Development, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan.
authors: Tsuneaki
authors: T
authors: Kenzaka
authors: Department of General Medicine, Toyooka Public Hospital, Toyooka, Japan.
authors: Ken
authors: K
authors: Kato
authors: Department of General Medicine, Toyooka Public Hospital, Toyooka, Japan.
authors: Akihito
authors: A
authors: Kitao
authors: Division of General Medicine, Center for Community Medicine, Jichi Medical University School of Medicine, Shimotsuke, Japan.
authors: Koki
authors: K
authors: Kosami
authors: Division of General Medicine, Center for Community Medicine, Jichi Medical University School of Medicine, Shimotsuke, Japan.
authors: Kensuke
authors: K
authors: Minami
authors: Department of General Medicine, Toyooka Public Hospital, Toyooka, Japan.
authors: Shinsuke
authors: S
authors: Yahata
authors: Department of General Medicine, Toyooka Public Hospital, Toyooka, Japan.
authors: Miho
authors: M
authors: Fukui
authors: Division of Community Medicine and Medical Education, Kobe University Graduate School of Medicine, Kobe, Japan.
authors: Masanobu
authors: M
authors: Okayama
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000641:Ammonia / Q000097:blood; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D022124:Hyperammonemia / Q000097:blood / Q000150:complications* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D014552:Urinary Tract Infections / Q000097:blood / Q000150:complications* / Q000628:therapy*
chemical_list: D000890:Anti-Infective Agents; D000641:Ammonia