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Hyperammonemia in the Critically Ill
- Patients with acute hyperammonemia have significant morbidity and mortality
- Fulminant hepatic failure is the most common cause of acute hyperammonemia in adult ICUs
- Other causes include TPN, GI hemorrhage, steroid use, trauma, multiple myeloma, infection with urease-splitting organisms, and drugs (salicylates, valproate)
- Cerebral edema, intracranial hypertension, seizures, and herniation are the most significant effects
- Initial management should focus on treating intracranial hypertension - mannitol, hypothermia, N-acetylcysteine have been used
- Lactulose has not been shown to reduce mortality in acute hyperammonemia but is unlikely to be harmful
Clay AS, Hainline BE. Hyperammonemia in the ICU. Chest 2007;132:1368-1378.