Journal of Acute Care

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VOLUME 3 , ISSUE 1 ( January-April, 2024 ) > List of Articles

CASE REPORT

Nonhepatic Hyperammonemia Secondary to Escherichia coli Urinary Tract Infection

Pooja C Patil

Keywords : Ammonia, Case report, Escherichia coli, Nonhepatic, Urease

Citation Information : Patil PC. Nonhepatic Hyperammonemia Secondary to Escherichia coli Urinary Tract Infection. 2024; 3 (1):35-37.

DOI: 10.5005/jp-journals-10089-0102

License: CC BY-NC 4.0

Published Online: 30-04-2024

Copyright Statement:  Copyright © 2024; The Author(s).


Abstract

Critically ill patients with hyperammonemia (HA) may suffer high morbidity and mortality. A 78-year-old male presented to a tertiary care hospital with a history of increased drowsiness for 3 days associated with intermittent fever and burning micturition. He was a known case of type 2 diabetes mellitus, systemic hypertension, and ischemic heart disease. Ultrasound abdomen revealed a thickening of the urinary bladder suggestive of cystitis. The renal and kidney function tests were normal. The serum ammonia level was 88 mg/dL (normal levels <40 mg/dL). Urine culture grew Escherichia coli (E. coli). Diagnosis as urinary tract infection (UTI) with E. coli and HA was made and the patient managed with parenteral meropenem, insulin, intravenous fluids, antihypertensives, low protein, and high-calorie diet. The patient's clinical condition improved gradually and later discharged home in hemodynamically stable condition. This case report highlights a rare case of HA secondary to E. coli-related UTI.


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  1. Nicolle LE. Uncomplicated urinary tract infection in adults including uncomplicated pyelonephritis. Urol Clin North Am 2008;35(1):1–12, v. DOI: 10.1016/j.ucl.2007.09.004
  2. Kenzaka T, Kato K, Kitao A, et al. Hyperammonemia in urinary tract infections. PLoS One 2015;10(8):e0136220. DOI: 10.1371/journal.pone.0136220
  3. Jacoby KJ, Singh P, Prekker ME, et al. Characteristics and outcomes of critically ill patients with severe hyperammonemia. J Crit Care 2020;56(4):177–181. DOI: 10.1016/j.jcrc.2019.12.005
  4. Sakusic A, Sabov M, McCambridge AJ, et al. Features of adult hyperammonemia not due to liver failure in the ICU. Crit Care Med 2018;46(9):e897–e903. DOI: 10.1097/CCM.0000000000003278
  5. Ribas GS, Lopes FF, Deon M, et al. Hyperammonemia in inherited metabolic diseases. Cell Mol Neurobiol 2021;42(8):2593–2610. DOI: 10.1007/s10571-021-01156-6
  6. Samtoy B, DeBeukelaer MM. Ammonia encephalopathy secondary to urinary tract infection with Proteus mirabilis. Pediatrics 1980;65(2):294–297.
  7. Prado FA, Delfino VD, Grion CM, et al. Hyperammonemia in ICU patients: a frequent finding associated with high mortality. J Hepatol 2015;62(5):1216–1218. DOI: 10.1016/j.jhep.2015.01.009
  8. Machado MC, Fonseca GM, Jukemura J. Late-onset ornithine carbamoyl transferase deficiency accompanying acute pancreatitis and hyperammonemia. Case Rep Med 2013;2013:903546. DOI: 10.1155/2013/903546
  9. Roberts SC, Bharat A, Kurihara C, et al. Impact of screening and treatment of ureaplasma species on hyperammonemia syndrome in lung transplant recipients: a single center experience. Clin Infect Dis 2021;73(9):2531–2537. DOI: 10.1093/cid/ciaa1570
  10. Nicholson C, Fowler M, Mullen C, et al. Evaluation of levocarnitine, lactulose, and combination therapy for the treatment of valproic acid-induced hyperammonemia in critically ill patients. Epilepsy Res 2021;178(12):106806. DOI: 10.1016/j.eplepsyres.2021.106806
  11. Matoori S, Leroux JC. Recent advances in the treatment of hyperammonemia. Adv Drug Deliv Rev 2015;90(8):55–68. DOI: 10.1016/j.addr.2015.04.009
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