Bhattacharyya Aniruddha, Ayele Girma M, Zinabu Samrawit W, Atalay Rediet Tefera, Mohammed Ahmad, Siraga Mahlet, Gao Lucia, Adithya Sateesh Bharadwaj, Gasmelseed Huda, Michael Miriam B
Internal Medicine, University of Maryland, Baltimore, USA.
Internal Medicine, Howard University Hospital, Washington, D.C., USA.
Cureus. 2024 Jul 1;16(7):e63607. doi: 10.7759/cureus.63607. eCollection 2024 Jul.
Hyperammonemia is a metabolic disorder characterized by supraphysiologic ammonia (NH) concentrations in the blood. Although usually seen in adults with liver disease, hyperammonemia is a notable complication in 4.1% of lung transplants. It is associated with cerebral edema and neurological dysfunction and carries up to 75% mortality in critically ill patients. Opportunistic infections caused by and species have been implicated as the cause of this metabolic disturbance. Literature in neonates has shown that renal replacement therapy (RRT) is the best choice for treating patients with neurologic manifestations of hyperammonemia, in cases of NH3 clearance than continuous renal replacement therapy (CRRT). In contrast, continuous venovenous hemodialysis (CVVHD) is usually better tolerated for patients with hemodynamic instability for NH clearance. NH is a small molecule whose clearance mirrors urea in dialysis. Even though RRT can be a treatment modality for hyperammonemia in adults and neonates, there is very little literature on adults. We present a unique case demonstrating improvement in neurologic manifestations of hyperammonemia by using both IHD and CVVHD in an adult patient.
高氨血症是一种代谢紊乱疾病，其特征是血液中氨（NH）浓度超过生理水平。虽然高氨血症通常见于患有肝脏疾病的成年人，但在4.1%的肺移植患者中，它是一种值得注意的并发症。它与脑水肿和神经功能障碍相关，在重症患者中的死亡率高达75%。由[具体菌种1]和[具体菌种2]引起的机会性感染被认为是这种代谢紊乱的原因。新生儿相关文献表明，对于有高氨血症神经表现的患者，在氨清除方面，肾脏替代治疗（RRT）是最佳选择，优于持续肾脏替代治疗（CRRT）。相比之下，对于有血流动力学不稳定的患者，在氨清除方面，持续静脉 - 静脉血液透析（CVVHD）通常耐受性更好。NH是一种小分子，其清除在透析中与尿素相似。尽管RRT可以作为成人和新生儿高氨血症的一种治疗方式，但关于成人的文献很少。我们报告了一个独特病例，该成年患者通过使用间歇性血液透析（IHD）和CVVHD改善了高氨血症的神经表现。
