Postbariatric Surgery Hyperammonemia: A Rare Cause of Encephalopathy.

Division

North Florida

Hospital

Largo Medical Center

Document Type

Case Report

Publication Date

7-1-2019

Keywords

gastric bypass surgery, hyperammonemic encephalopathy, urea cycle disorder, complications, obesity

Disciplines

Analytical, Diagnostic and Therapeutic Techniques and Equipment | Pathological Conditions, Signs and Symptoms | Surgical Procedures, Operative | Therapeutics

Abstract

Hyperammonemic encephalopathy is an under-recognized and potentially fatal complication of Roux-en-Y gastric bypass surgery. We present a case of a 42-year-old woman with no known history of liver disease who experienced worsening encephalopathy 1 year after bariatric surgery. She presented with elevated ammonia and severe encephalopathy requiring intubation. A complete workup led to the diagnosis of a urea cycle disorder. The patient was managed with lactulose, ammonia scavenging agents, and nutritional supplementation with a favorable outcome. We report this case to increase awareness of this condition and urge providers to maintain a high clinical suspicion in the appropriate setting.

Publisher or Conference

ACG Case Reports Journal

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