Department of Respiratory Medicine, National Hospital Organization Higashi-ohmi General Medical Center, Japan.
Intern Med. 2023 Sep 1;62(17):2527-2529. doi: 10.2169/internalmedicine.0922-22. Epub 2023 Feb 1.
A 91-year-old woman was brought to our hospital with altered consciousness. Blood tests showed an increased ammonia level of 468 μg/dL and a normal liver function. Chest computed tomography showed massive right pleural effusion with loculation. We immediately performed chest drainage using two drainage tubes. The pleural effusate pH was 8.5. We diagnosed her with right empyema leading to hyperammonemia and initiated ampicillin/sulbactam therapy. However, she developed progressive renal failure and died on the third day. Empyema caused by urease-producing bacteria can lead to hyperammonemia. This is the first report of hyperammonemia due to empyema in the English literature.
一位 91 岁女性因意识改变被送往我院。血液检查显示血氨水平升高至 468μg/dL，肝功能正常。胸部 CT 显示大量右侧胸腔积液伴分隔。我们立即使用两根引流管进行胸腔引流。胸腔积液 pH 值为 8.5。我们诊断她患有导致高血氨的右侧脓胸，并开始使用氨苄西林/舒巴坦治疗。然而，她随后出现进行性肾衰竭并于第 3 天死亡。产脲酶细菌引起的脓胸可导致高血氨。这是英文文献中首例脓胸导致高血氨的报告。
