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Case report
Non-cirrhotic hyperammonaemia: are we missing the diagnosis?
  1. Yi Lin Lee1,
  2. Siying Pang2 and
  3. Caroline Ong2
  1. 1Department of Surgical Intensive Care, Singapore General Hospital, Singapore
  2. 2Department of Anaesthesiology Intensive Care and Pain Medicine, Tan Tock Seng Hospital, Singapore
  1. Correspondence to Dr Yi Lin Lee; lee.yi.lin{at}


Hepatic encephalopathy secondary to hyperammonaemia is a known complication of chronic liver disease. In contrast, non-cirrhotic hyperammonaemia is a lesser-known entity that should be considered in a patient with acute encephalopathy as part of the diagnostic workup as prompt identification can help to avoid complications such as seizures and cerebral oedema. We present a case of a middle-aged woman who presented electively for a total pancreatectomy–duodenectomy with splenectomy, hepatico-jejunostomy, gastro-jejunostomy and developed encephalopathy on postoperative day 10 due to non-cirrhotic hyperammonaemia.

  • liver disease
  • pancreas and biliary tract
  • adult intensive care
  • portal vein

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  • Contributors YLL: writing of manuscript; SP: writing of manuscript; CO: review of manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

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

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