Hyperammonemia complicating parenteral nutrition in infants

Abstract

The parenteral administration of protein hydrolysate-glucose mixtures is being used increasingly to prevent tissue catabolism and promote growth in infants with various conditions which preclude adequate ingestion or absorption of calories. Although nitrogen retention can be regularly attained, several complications have been reported.We have found elevated blood ammonia levels in 5 of 6 infants receiving parenteral nutrition. In 4 of these infants, blood ammonia was >200μ g%. All 3 low-birth weight infants in the series developed hyperammonemia. Elevations of blood ammonia were seen during the infusion of either casein or fibrin hydrolysates. In 2 infants receiving long term infusions the level of blood ammonia correlated directly with the rate of infusion of protein hydrolysate whereas blood urea nitrogen levels did not change significantly. Elevation of serum transaminases and bilirubin accompanied hyperammonemia in 3 patients.These data show that hyperammonemia is a common biochemical abnormality in newborn infants receiving parenteral nutrition with casein or fibrin hydrolysates at commonly employed infusion rates. Liver cell damage may accompany this mode of nutrition. The cause of hyperammonemia is unknown, but may be the result of an amino acid imbalance in the infusate.