SHM Converge Scientific Abstract ePoster Gallery-Hypercatabolic Hyperammonemia: A Burn Patient With Unexplained Encephalopathy

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This case report describes a 55-year-old woman with severe burns affecting 70% of her body, sustained four months earlier, who was admitted with altered mental status after a recent COVID-19 infection. On arrival, she also had acute kidney injury and a urinary tract infection, and she was treated with antibiotics and fluids. Despite treatment, her encephalopathy persisted. An extensive workup was unrevealing except for marked hyperammonemia, with an ammonia level of 275 µ/dL.<br /><br />Lactulose was started, but ammonia levels improved only minimally. Her course was further complicated by poor oral intake and recurrent hypoglycemia, prompting placement of a nasogastric feeding tube. After enteral nutrition was resumed, her ammonia level normalized within two days and her mental status returned to baseline by discharge.<br /><br />The authors emphasize that ammonia is normally cleared through the urea cycle, and elevated levels most commonly occur with liver disease. However, in hypercatabolic states such as severe burns with inadequate nutrition, accelerated muscle breakdown can generate enough ammonia to overwhelm the urea cycle, leading to noncirrhotic hyperammonemic encephalopathy. This case highlights the importance of considering hyperammonemia as a cause of unexplained encephalopathy in burn patients, especially when nutritional intake is poor and catabolism is high.

Asset Subtitle

Joel Joseph

Meta Tag

Author List Joel Joseph, Luqman-Arafath Thazhatuveetil-Kunhahamed, Sumera Andleeb

Category Clinical Vignettes

Concept Hyperammonemia

Concept Hyperammonemic Encephalopathy

Concept Hypercatabolic State

Concept Urea Cycle

Concept Altered Mental Status

Distinguished Non-Finalist

Presenter Organization Wake Forest School of Medicine

Presenting Author Joel Joseph

Track Adult

Keywords

severe burns

hyperammonemia

encephalopathy

noncirrhotic hyperammonemic encephalopathy

burn patient

catabolic state

lactulose

enteral nutrition

acute kidney injury

urinary tract infection

Hyperammonemia

Hyperammonemic Encephalopathy

Hypercatabolic State

Urea Cycle

Altered Mental Status