TY - JOUR
T1 - A 6-year-old boy with hyperammonaemia
T2 - Partial N-acetylglutamate synthase deficiency or portosystemic encephalopathy?
AU - Broere, Daniel
AU - Van Gemert, Wim G.
AU - Kneepkens, C. M.Frank
AU - Neele, Diana M.
AU - Manoliu, Radu A.
AU - Rauwerda, Jan A.
AU - Van der Knaap, Marjo S.
PY - 2000
Y1 - 2000
N2 - We describe a 6-year-old boy admitted with lethargy and somnolence. Laboratory tests showed hyperammonaemia (arterial level 186 μmol/1) and slightly elevated prothrombin time. The patient was treated with sodium benzoate, lactulose and a protein-restricted diet. This resulted in an insufficient decrease in blood ammonia levels. Metabolic investigations were unrevealing apart from a slightly elevated urinary glutamine concentration. Liver tissue showed steatosis and mildly decreased activity of N-acetylglutamate synthase suggesting partial deficiency. Treatment with N-carbamyl glutamate did not affect serum ammonia levels. Colour Doppler sonography and MR angiography demonstrated a patent ductus venosus. After surgical ligation of the ductus venosus, serum ammonia levels returned to normal and mental and motor performance improved markedly. Conclusion: In late onset hyperammonaemia, partial N-acetylglutamate synthase deficiency and portocaval shunt should be ruled out.
AB - We describe a 6-year-old boy admitted with lethargy and somnolence. Laboratory tests showed hyperammonaemia (arterial level 186 μmol/1) and slightly elevated prothrombin time. The patient was treated with sodium benzoate, lactulose and a protein-restricted diet. This resulted in an insufficient decrease in blood ammonia levels. Metabolic investigations were unrevealing apart from a slightly elevated urinary glutamine concentration. Liver tissue showed steatosis and mildly decreased activity of N-acetylglutamate synthase suggesting partial deficiency. Treatment with N-carbamyl glutamate did not affect serum ammonia levels. Colour Doppler sonography and MR angiography demonstrated a patent ductus venosus. After surgical ligation of the ductus venosus, serum ammonia levels returned to normal and mental and motor performance improved markedly. Conclusion: In late onset hyperammonaemia, partial N-acetylglutamate synthase deficiency and portocaval shunt should be ruled out.
KW - Atretic encephalocele
KW - Hyperammonaemia
KW - Partial N-acetylglutamate synthase deficiency
KW - Patent ductus venosus (Arantii)
KW - Portosystemic encephalopathy
UR - http://www.scopus.com/inward/record.url?scp=0033695766&partnerID=8YFLogxK
U2 - https://doi.org/10.1007/PL00008367
DO - https://doi.org/10.1007/PL00008367
M3 - Article
C2 - 11131349
SN - 0340-6199
VL - 159
SP - 905
EP - 907
JO - European journal of pediatrics
JF - European journal of pediatrics
IS - 12
ER -