Abstract
A 74-year-old man on chronic hemodialysis therapy since 1993 was admitted for evaluation of a mass in the right hypochondrial region, abdominal pain and high fever (40°C) on May 11, 1994. Laboratory examinations and abdominal CT revealed an inflammatory mass of adipose-like tissue. After administration of antibiotics and total parenteral nutrition [TPN; water (1, 490ml), calories (1, 150 kcal), amino acids (15g=AMI-U® 200ml), non-protein. calories/N (605)], the clinical symptoms improved and the size of the abdominal mass decreased. TPN was continued because of the presence of nausea and vomiting. On June 10 (30 days after the start of TPN), the patient became somnolent, and became comatose on June 13. The plasma NH3 concentration had increased to 186μg/dl, but other laboratory data, including the results of liver function tests remained within the normal range. Discontinuation of AMI-U® and infusion of Aminolevan® gradually improved the patient's consciousness level and reduced the plasma concentration of NH3 to within the normal range.
AMI-U® has been prescribed as a source of essential amino acids (e. a. a) in patients with renal failure. However, several studies have demonstrated that long-term administration of e. a. a. without non-e. a. a. may lead to the metabolic complication of hyperammonemic encephalopathy in renal failure patients. The present case indicates that both non-e. a. a. and e. a. a. be administered in TPN solutions for renal failure patients.
