RESUMEN
Hyperammonemia is a metabolic disorder characterized by supraphysiologic ammonia (NH3) concentrations in the blood. Although usually seen in adults with liver disease, hyperammonemia is a notable complication in 4.1% of lung transplants. It is associated with cerebral edema and neurological dysfunction and carries up to 75% mortality in critically ill patients. Opportunistic infections caused by Mycoplasma and Ureaplasma species have been implicated as the cause of this metabolic disturbance. Literature in neonates has shown that renal replacement therapy (RRT) is the best choice for treating patients with neurologic manifestations of hyperammonemia, in cases of NH3 clearance than continuous renal replacement therapy (CRRT). In contrast, continuous venovenous hemodialysis (CVVHD) is usually better tolerated for patients with hemodynamic instability for NH3 clearance. NH3 is a small molecule whose clearance mirrors urea in dialysis. Even though RRT can be a treatment modality for hyperammonemia in adults and neonates, there is very little literature on adults. We present a unique case demonstrating improvement in neurologic manifestations of hyperammonemia by using both IHD and CVVHD in an adult patient.
RESUMEN
Postpartum depression is a common mental health disorder that affects women within six months after giving birth. It is characterized by sadness, anxiety, and extreme fatigue, which can significantly impact a woman's daily functioning and ability to care for her newborn. While traditional treatments for postpartum depression include therapy and medication, recent studies have shown promising results using ketamine. We present a case of a woman with a history of depression who delivered four children by cesarean section with debilitating postpartum depression in two births and no symptoms of depression in the births where she received ketamine during delivery.