PDF(Pubmed)
Abstract：
Hyperammonemic encephalopathy (HE) can be broadly defined as an alteration in the level of consciousness due to elevated blood ammonia level. While hepatic cirrhosis is the most common cause of HE, non-hepatic causes like drugs, infections, and porto-systemic shunts can also lead to the presentation. In this case, we highlight an unusual occurrence of recurrent non-cirrhotic HE from obstructive urinary tract infection (UTI) with urea-splitting micro-organisms in an elderly male patient. The patient exhibited altered mentation, and elevated ammonia levels with normal hepatic function at presentation. Urine culture revealed Proteus mirabilis resistant to extended spectrum beta-lactamases (ESBL). Successful management of obstructive UTI was achieved through Foley\'s catheterization and intravenous (IV) antibiotics, resulting in the resolution of HE. This outcome further supports the significance of UTI as a potential cause of hyperammonemia. Thus, UTI as one of the non-hepatic causes of hyperammonemia should always be explored among elderly patients presenting with altered mentation.
摘要：
高氨血症性脑病（HE）可以广泛定义为由于血氨水平升高而引起的意识水平的改变。虽然肝硬化是HE的最常见原因，非肝原因如药物，感染,和波尔图系统分流也可以导致演示。在这种情况下,我们强调了一名老年男性患者因尿路梗阻感染(UTI)合并尿素分解微生物引起的复发性非肝硬化性HE的异常发生.患者表现出精神改变，和氨水平升高，肝功能正常。尿液培养显示奇异变形杆菌对超广谱β-内酰胺酶（ESBL）具有抗性。通过Foley的导管插入术和静脉（IV）抗生素成功治疗阻塞性UTI，导致了他的决议。该结果进一步支持UTI作为高氨血症的潜在原因的重要性。因此，UTI作为高氨血症的非肝脏原因之一，应始终在出现状态改变的老年患者中进行探索。
