Abstract
A 78-year-old woman presented with recurrent encephalopathy after hemodialysis initiation. Her medical history included end-stage renal disease, congestive heart failure, and cerebral infarction. Her medication included aspirin, losartan, carvedilol, pravastatin, and lansoprazole. Maintenance hemodialysis was initiated because of refractory volume overload. Two days after dialysis initiation, she was noted to be comatose with hyperammonemia (205 μg/dl). Branched-chain amino acid infusion was administered, resulting in improvement of her mental status.
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