HealthDay News — Severe hyperammonemia, resulting from ammonia that accumulates in stored blood products, should be considered in the setting of cirrhosis, according to a case report published online June 13 in the Annals of Internal Medicine.

Zachary M. Rossfeld, MD, and Nathan R. Wright, MD, from The Ohio State University in Columbus, describe a 58-year-old patient who presented to the emergency room with chest pain and syncope, with a history of cirrhosis due to non-alcoholic steatohepatitis. He was diagnosed with non-ST-segment elevation myocardial infarction and was administered 1 unit of packed red blood cells that had been collected 17 days earlier. The following day, he was administered 2 more units of packed red blood cells that had been obtained 17 and 20 days earlier.

The authors note that the patient was lethargic with a rapidly deteriorating mental state at 6 hours after the last blood transfusion. No bleeding or herniation was revealed on a non-contrast-enhanced computed tomography scan of the head, and the patient was intubated. He stopped moving spontaneously and developed cranial nerve palsies. The patient’s serum ammonia level was 806 µmol/L, compared with 53 µmol/L on admission. Urgent dialysis was started and the patient regained spontaneous movement within 24 hours. 

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“On the basis of this experience, we recommend that severe hyperammonemia be considered when patients with cirrhosis develop altered mental status after blood transfusion,” the authors write.

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