Hyperammonaemia is an important cause of lethargy. In this article, we describe a lesser-known but potential fatal cause of hyperammonaemia. A 27-year-old woman presented with lethargy caused by hyperammonaemia. She was treated with the emergency regime that is used to treat hyperammonaemia in urea cycle defects. Although this effectively lowered the ammonia levels, the clinical situation of the patient initially deteriorated and she was transferred to the Intensive Care Unit and intubated. Urine culture identified Proteus mirabilis, a urea-splitting bacterium that caused the hyperammonaemia. Prompt and adequate treatment with antibiotics and adequate drainage of urine was started and she completely recovered. Although every patient can get hyperammonaemia caused by urinary tract infection with urea-splitting bacteria, patients with structural bladder abnormalities are at greater risk. Lethargy can be the only presenting symptom. When recognized early, it is quite treatable and has a good prognosis.

Additional Metadata
Persistent URL hdl.handle.net/1765/120242
Journal Nederlands Tijdschrift voor Geneeskunde
Citation
Driessen, L.M, du Pré, B.C. (Bastiaan C.), Klein Nagelvoort-Schuit, S.C.E, Langendonk, J.G, Zandbergen, A.A.M, & Wagenmakers, M.A.E.M. (Margreet A E M). (2019). Reduced consciousness levels caused by hyperammonaemia Bewustzijnsdaling door hyperammoniëmie. Nederlands Tijdschrift voor Geneeskunde, 163. Retrieved from http://hdl.handle.net/1765/120242