A patient with hemodialysis-related hyperammonemic encephalopathy: a delayed presentation of congenital arterioportal fistulas.
Clin Nephrol
; 79(6): 499-503, 2013 Jun.
Article
em En
| MEDLINE
| ID: mdl-23725650
ABSTRACT
We present a 32-year-old woman who developed hyperammonemic encephalopathy during hemodialysis. She was rather well before 2009 when receiving peritoneal dialysis due to chronic interstitial nephritis. Due to a refractory peritonitis, the treatment was shifted to hemodialysis in January 2009. About 1 year later, she was found with consciousness disturbance during hemodialysis then admitted to the hospital because of hyperammonemia (165 µg/dl). During hospitalization, the patient's abdominal Doppler sonography showed a hepatofugal flow in the portal trunk while the hepatic artery angiography demonstrated multiple intrahepatic arterioportal fistulas. Her general condition was improved after the treatment of lactulose and hepatic artery embolization. With the occurrence of arterioportal fistulas induced portal hypertension, we speculated that the portal-systemic shunt was enhanced during hemodialysis because of venous hypotension which then resulted in the transient hyperammonemia. To the best of our knowledge, this is the first patient who developed hemodialysis- related hyperammonemic encephalopathy due to multiple arterioportal fistulas.
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Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Veia Porta
/
Encefalopatia Hepática
/
Fístula Arteriovenosa
/
Diálise Renal
/
Hiperamonemia
/
Artéria Hepática
Tipo de estudo:
Diagnostic_studies
/
Etiology_studies
Limite:
Adult
/
Female
/
Humans
Idioma:
En
Revista:
Clin Nephrol
Ano de publicação:
2013
Tipo de documento:
Article
País de afiliação:
Taiwan