A Case of Status-Epilepticus-Associated Transient Hyperammonemia in the Emergency Department

Brittany Pelsue,Jonathan G Rogg

doi:10.1155/2017/9436095

Abstract

This report describes a case of transient hyperammonemia following tonic-clonic status epilepticus with an initial ammonia level of 537 Umol/L. This appears to be the highest transient ammonia level reported in the literature in this clinical scenario. This is an affirmation that an initial elevated ammonia level in the absence of hepatic dysfunction should be interpreted with caution when associated with status epilepticus. Repeat levels should be drawn to identify transient hyperammonemia and determine the need for treatment if levels do not decrease.

Highlights

In patients presenting to the emergency department with seizure-like activity, ammonia levels may be part of the initial workup
It was found that transient hyperammonemia was associated with tonic-clonic seizures, male gender, diabetes, and alcohol related seizures
The patient ingested cocaine and methamphetamines prior to arrival, both of which have stimulant effects and have the potential to have caused her seizure activity. Neither of these illicit drugs has a causal link to hyperammonemia, a case report described an ammonia level of 91 Umol/L following methamphetamine use [6]

Summary

Introduction

In a prospective observational study of 121 patients it was described that, in transient hyperammonemia, ammonia levels return to normal within 8 hours [4]. In this same study, it was found that transient hyperammonemia was associated with tonic-clonic seizures, male gender, diabetes, and alcohol related seizures. The range of ammonia detection in this study was 94 mcg/dL (67 Umol/L)–250 mcg/dL (178 Umol/L), with previous case reports documenting levels up to 392 mcg/dL (279.8 Umol/L) [5] It has been established in the adult population that, because of the temporary nature of this laboratory abnormality, transient hyperammonemia in this setting does not require intervention

Case Presentation

Discussion

Conclusion