A case of hemodialysis for acute hyperammonemia associated with urea cycle abnormality

Abstract

Hyperammonemia associated with inborn errors of metabolism in newborns causes non-specific neurological abnormalities, so it is necessary to remove blood ammonia promptly, and blood purification therapy by extracorporeal circulation is indicated. Therefore, we report an example of devising continuous renal replacement therapy and adjusting treatment conditions for acute hyperammonemia. The case was a boy with OTC deficiency, the target value of ammonia was 150 μg/dL or less from the second day after birth (day 0), and the osmotic pressure was measured by CT at any time to confirm that there was no cerebral edema and continuous renal replacement. The therapy was started. The serum ammonia level before the start of treatment was 3,426 μg/dL, and after the start of treatment, the improvement was slight, so the dialysate flow rate was gradually increased to 300 mL/hr. No abnormal findings were found on the head CT due to the fine adjustment of dialysis efficiency and the adjustment of osmotic pressure by medication. On the 5th day of illness, continuous renal replacement therapy was withdrawn, and on the 19th day of illness, he was transferred to the referral hospital.