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    Multifactorial non-cirrhotic hyperammonaemic encephalopathy

    Access Status
    Fulltext not available
    Authors
    Triplett, K.
    Murray, R.
    Anstey, Matthew
    Date
    2018
    Type
    Journal Article
    
    Metadata
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    Citation
    Triplett, K. and Murray, R. and Anstey, M. 2018. Multifactorial non-cirrhotic hyperammonaemic encephalopathy. BMJ Case Reports. 2018: Article ID
    Source Title
    BMJ Case Reports
    DOI
    10.1136/bcr-2017-223245
    ISSN
    1757-790X
    School
    School of Public Health
    URI
    http://hdl.handle.net/20.500.11937/67879
    Collection
    • Curtin Research Publications
    Abstract

    A 51-year-old female presented with acute confusion associated with a non-specific headache and lethargy. The patient's history included bipolar disorder on valproate and recent travel to northern Vietnam. The patient was subsequently found to have hyperammonaemia as well as a urinary tract infection and bacteraemia with Klebsiellapneumoniae. The patient was presumed to have a multifactorial non-cirrhotic hyperammonaemic encephalopathy due to a combination of a urinary tract infection and bacteraemia with K. pneumoniae, a urease-producing bacteria, and also valproate use, a medication known to interfere with ammonia elimination. The patient's treatment included supportive care, ceasing valproate, empiric then rationalised antibiotics, N-acetylcysteine and L-carnitine. We present a case of non-cirrhotic hyperammonaemic encephalopathy and explain why it is multifactorial in origin.

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