Haemodialysis for hyperammonaemic encephalopathy

Ten of them were donated, the rest were bought.The of 261.4±11.4vs 262.6±47.2ml/min) and comparable to those reported in vitro by Cordoba et al. [2].The purpose additional patients consisted of 33 men and 26 women with a mean age of 29±13 years (range 11-61).The time they of the present communication is to confirm the usefulness of haemodialysis for hyperammonaemic encephalopathy and to had been trapped ranged from 3 to 72 h (11±14).Oliguric acute renal failure had developed in 50 patients (84.7%).verify measured clearances.Mean duration of oliguria in the patients was 10.1±7.3 days Case.A 59-year-old female was brought to the emergency (1-36).On admission, mean serum creatinine level was room with decreased alertness over a few few hours.She had 3.8±2.0mg/dl.The peak serum creatinine level reached was known congenital uropathy which had required a right 6.0±2.2 mg/dl (2.6-12.6).The peak serum CPK level was nephrectomy and an ureterosigmoidostomy. History was 9235±20 126 U/l (247-86 440).The mean number of dialysis negative except for a deliberate discontinuation of laxatives session days was 14. 7±9.8 (2-48).the week before.Initial biochemistry serum results were as We eliminated pre-renal factors in patients who had follows: creatinine 89 mmol/l, urea 10.3 mmol/l, sodium oliguria and/or elevated serum creatinine levels.We tried to 147 mmol/l, chloride 119 mmol/l, bicarbonates 14.5 mmol/l.increase urine flow and achieve fluid-electrolyte and acid-Arterial pH was 7.32 with a pCO 2 of 28.5 mmHg.A bicarbonbase balance.Dialysis was started even in patients with ate infusion was initiated and netilmycine was empirically serum BUN, creatinine, potassium and bicarbonate levels given intravenously.Because of neurological deterioration, slightly above or below normal limits.Patients tended to be she was intubated and transferred to the ICU.Serum ammovolume depleted and in many instances a large amount of nia concentration drawn upon admission came back markserum was lost from wounds.The patients received adequate edly elevated at 228 mmol/l and increased to 379 mmol/l 5 h volume replacement with human albumin, plasma, whole later when the patient deteriorated.blood, dextrose or hypotonic sodium chloride solutions A temporary dialysis catheter was inserted, the bicarbonate during dialysis sessions, whenever required.Forty-eight infusion was stopped and intermittent haemodialysis was patients were treated with haemodialysis, two with continuinitiated using a CT-190G dialyser (1.9 m2 triacetate celluous slow haemodiafiltration and 11 with both dialysis modallosic membrane manufactured by Baxter Healthcare ities.The total number of dialysis sessions reached 881.Corporation, McGaw Park, IL, USA) at a blood flow rate Nearly all patients had severe limb trauma, 37 of them of 450 ml/min and a dialysate flow rate of 500 ml/min.Blood underwent fasciotomy for compartmental syndrome and 10 was drawn pre-and post-dialyser every hour for ammonia required amputation.Injury sites were as follows: lower determination during haemodialysis which was maintained extremity 33; upper and lower extremities 12; upper extremity over 4 h and 50 min.Mean blood-side ammonia, urea, and 4; multiple trauma 4; trunk 3; and trunk and lower extremity creatinine clearances were respectively 289.8±25.5, 3. Sigmoid colon had to be resected in one patient with 352.2±16.8, and 180.3±10.8ml/min; pre-dialyser blood abdominal trauma.Two patients had urinary bladder rupammonia was reduced to 4 mmol/l when dialysis was discontures repaired.Many wounds were infected.Thirty-one tinued; however, a rebound was observed with an increased patients had systemic infections.Most of the patients received concentration to 41 mmol/l 2 h after the end of dialysis.ceftazidime plus metronidazole as antibiotic regimen whereasThe patient became progressively more alert over the next others were given vancomycine and/or imipenem, according 12 hours and an abdominal ultrasound confirmed acute left to blood culture results.pyelonephritis.A long-term treatment with lactulose and Twenty of the 59 patients died (33.9%), 12 from multiple oral sodium bicarbonate was prescribed and she was disorgan failure caused by sepsis, two from massive haemorcharged from the ICU.Two days later, she was readmitted rhage (retroperitoneal haematoma) and 6 from other types to the ICU because of decreased alertness.Ammonia level of circulatory failure.The renal function of the other patients was 72 mmol/l and the treatment consisted in oral ciprofloxrecovered with time.Further, more detailed, analysis of the acin, sodium benzoate, and lactulose administered more injured patients is in progress.frequently.Two weeks later, she was finally discharged from Though treatment possibilities for chronic renal failure the hospital.Urological follow-up has resulted in the modipatients are not sufficient in our country, we attempted to fication of the type of urinary diversion with the purpose of treat all the acute renal failure patients of the earthquake reducing associated complications [3].disaster with tremendous effort together with national and international assistance.Although the terrible disaster weComment.The present report emphasizes the importance of have lived through was a dreadful event, it greatly increased recognizing hyperammonaemic encephalopathy complicating the experience of nephrologists of crush syndromes.urinary diversions and, if possible, preventing its occurrence.In case of a severe encephalopathy, haemodialysis can be a Department of Adult Nephrology Mahmut Yavuz useful adjunct offering rapid lowering of blood ammonia 1Department of Paediatric Alpaslan Ersoy concentrations.The evolution of our patients and the Nephrology Osman Do ¨nmez1 obtained intra-dialytic clearances confirm these findings.

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