rss
BMJ Case Reports 2018; doi:10.1136/bcr-2017-223245
  • Unusual presentation of more common disease/injury
  • CASE REPORT

Multifactorial non-cirrhotic hyperammonaemic encephalopathy

  1. Matthew Anstey1,4
  1. 1Intensive Care, Sir Charles Gairdner Hospital, Nedlands, Australia
  2. 2Infectious Diseases and PathWest Laboratory Medicine, Sir Charles Gairdner Hospital, Nedlands, Australia
  3. 3School of Pathology and Laboratory Medicine, University of Western Australia, Nedlands, Australia
  4. 4School of Medicine and Pharmacology, University of Western Australia, Nedlands, Australia
  1. Correspondence to Dr Katherine Elizabeth Triplett, katherine.vautin{at}health.wa.gov.au
  • Accepted 16 February 2018
  • Published 9 March 2018

Summary

A 51-year-old female presented with acute confusion associated with a non-specific headache and lethargy. The patient’s history included bipolar disorder on valproate and recent travel to northern Vietnam. The patient was subsequently found to have hyperammonaemia as well as a urinary tract infection and bacteraemia with Klebsiellapneumoniae. The patient was presumed to have a multifactorial non-cirrhotic hyperammonaemic encephalopathy due to a combination of a urinary tract infection and bacteraemia with K. pneumoniae, a urease-producing bacteria, and also valproate use, a medication known to interfere with ammonia elimination. The patient’s treatment included supportive care, ceasing valproate, empiric then rationalised antibiotics, N-acetylcysteine and L-carnitine. We present a case of non-cirrhotic hyperammonaemic encephalopathy and explain why it is multifactorial in origin.

Footnotes

  • Contributors KET was responsible for identification of the case, the literature review, drafting the manuscript and for approving the final version. RM and MA were responsible for identification of the case, revising the manuscript critically and for approving the final version.

  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

Register for free content

The full text of all Editor's Choice articles and summaries of every article are free without registration

The full text of Images in ... articles are free to registered users

Only fellows can access the full text of case reports (apart from Editor's Choice) - become a fellow today, or encourage your institution to, so that together we can grow and develop this resource

Don't forget to sign up for content alerts so you keep up to date with all the case reports as they are published, and let us know what you think by commenting on the Editor's blog

Navigate This Article