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Hyperammonemia in a Patient with Short Bowel Syndrome and Chronic Renal Failure
Keitaro Yokoyama a , Yosuke Ogura a , Masateru Kawabata a , Fumihiko Hinoshita a , Yoshio Suzuki a , Sigeko Hara a , Akira Yamada a , Nobuhide Mimura a , Masaaki Nakayama b , Yoshindo Kawaguchi b , Osamu Sakai b
18 December 2008
Short bowel syndrome, Arginine, Renal insufficiency, Hyperammonemia, Disturbed consciousness
Abstract
A patient with short bowel syndrome (SBS) and renal failure developed a disturbance of consciousness associated with hyperammonemia. Abnormally low concentrations of ornithine, citrulline, and arginine were observed on the plasma aminogram. These results suggested that the activities of amino acid synthetase localized in the small intestinal flora were lost. The small intestine is required for arginine synthesis; thus, infusion limited to the essential amino acids to SBS patients will cause a deficiency of the urea cycle intermediates, ornithine, citrulline, and arginine and may lead to hyperammonemia. In addition, the renal insufficiency may have caused decreased excretion of ammonia. In this patient, supplemental arginine improved the symptoms.
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