Goda Toshiaki, Watanabe Kotaro, Kobayashi Junya, Nagai Yasuharu, Ohara Nobuyuki, Takahashi Daisuke
Department of Vascular Neurology, National Hospital Organization Osaka Minami Medical Center.
Rinsho Shinkeigaku. 2017 Mar 28;57(3):130-133. doi: 10.5692/clinicalneurol.cn-001002. Epub 2017 Feb 22.
A 79-year-old woman was admitted emergently for disturbance of consciousness. Her consciousness level was Japan coma scale 20, and she presented with hypermyotonia. Brain magnetic resonance imaging and cerebrospinal fluid examination showed normal findings. Her blood tests showed an increased ammonia level of 291 μg/dl with normal liver function. We catheterized the bladder for urinary retention. Eight hours after admission, the blood level of ammonia decreased to 57 μg/dl and the patient's consciousness level improved. Corynebacterium pseudodiphtheriticum, which is a bacteria producing urease, was detected from a urine culture. It is important to recognize that obstructive urinary tract infection caused by urease-producing bacteria can cause hyperammonemia.
一名79岁女性因意识障碍紧急入院。她的意识水平为日本昏迷量表20级，且伴有肌张力亢进。脑磁共振成像和脑脊液检查结果均正常。她的血液检查显示氨水平升高至291μg/dl，肝功能正常。因尿潴留我们对其进行了膀胱插管。入院8小时后，血液氨水平降至57μg/dl，患者意识水平有所改善。从尿培养中检测出了产脲酶的假白喉棒状杆菌。认识到由产脲酶细菌引起的梗阻性尿路感染可导致高氨血症很重要。
