Successful management of hyperammonemia syndrome in a patient after skin transplantation: a case report and a literature review on 41 patients.
10.3760/cma.j.issn.2095-4352.2019.03.022
- Author:
Weili WANG
1
;
Sinan GAO
;
Yisheng KANG
;
Lixin YU
;
Yihe LIU
;
Zhongyang SHEN
Author Information
1. Department of Organ Transplantation, Tianjin First Center Hospital, Tianjin 300192, China. Corresponding author: Shen Zhongyang, Email: zhongyangshen@vip.sina.com.
- Publication Type:Journal Article
- MeSH:
Female;
Humans;
Hyperammonemia/therapy*;
Intensive Care Units;
Review Literature as Topic;
Skin Transplantation/adverse effects*;
Treatment Outcome
- From:
Chinese Critical Care Medicine
2019;31(3):367-370
- CountryChina
- Language:Chinese
-
Abstract:
Hyperammonemia syndrome (HS) is a comparatively rare but often fatal clinical syndrome characterized by progressive respiratory alkalosis and abrupt mental status alteration associated with markedly elevated plasma ammonium levels. Although the exact mechanism of HS remains unclear, infection with urease producing microbes is proposed as the main etiology of HS recently. A patient with HS after repeated autologous skin transplantation was admitted to Tianjin First Center Hospital in March 2018, presented with fever, coma and epilepsy. The infection of Mycoplasma hominis was confirmed in blood sample by high throughput gene detection. The patient was survived after multimodal management including antimicrobial treatment, aggressive ammonia removal by continuous renal replacement therapy in combination with lactulose, and mechanical ventilation. She was successfully discharged from intensive care unit (ICU) with clear consciousness, normal temperature and smooth breath. In view of the experience of the case treatment, a review of literature was conducted to discuss the epidemiology and clinical characteristics, possible etiologies and mechanisms, and outcomes with emphasis on treatment strategies of HS and to promote more clinicians to recognize this rare disease.
