2021 Volume 54 Issue 11 Pages 591-596
A 78‒year‒old female was transferred to our facility with a disturbance of consciousness. She had been undergoing hemodialysis for chronic renal failure caused by pregnancy‒induced hypertension for 11 years. One year earlier, she had started to experience disturbances of consciousness during or after dialysis sessions. She was subsequently diagnosed with hyperammonemia at another hospital and was administered lactulose and branched‒chain amino acid therapy. Her condition improved; however, her symptoms had recurred two months ago, and she was admitted to our hospital. Laboratory tests showed that her serum ammonia level was 190 ug/dL. Contrast‒enhanced computed tomography revealed a portosystemic shunt, and she was diagnosed with cirrhosis and hepatic encephalopathy secondary to non‒alcoholic steatohepatitis. The hepatic encephalopathy was attributed to reduced intrahepatic blood flow secondary to the hemodialysis‒induced diversion of blood into extrahepatic shunts. The patient and her family refused invasive treatment; therefore, rifaximin was administered to eliminate ammonia‒producing gastrointestinal bacteria. Her serum ammonia level rapidly decreased to approximately 100 ug/dL, and her level of consciousness improved and has remained stable for a year.
