Lethargy and Hyperammonemia in a Neonate

Abstract

History of Present Illness The infant was delivered at 39 weeks gestational age following the uneventful pregnancy of her mother (G2P2). She began breast-feeding without difficulty and went home 2 days after delivery. That evening, approximately 24 hours prior to presentation at our tertiary care pediatric medical center, she became lethargic and would not awaken for feeding. She was taken first to her primary care physician (PCP), where she was found to be breathing deeply. She was subsequently transferred to a local hospital. While at this hospital, plasma ammonia testing was performed, and the level was 700 μmol/L (normal reference range: 64-107 μmol/L). She was subsequently intubated and given D10 fluid intravenously; after blood, urine, and cerebrospinal fluid (CSF) samples were obtained for culture, she was given ampicillin and claforan antibiotics. She was then transferred to our tertiary care pediatric medical center for further treatment.