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Hyperammonemia in the Pediatric Emergency Care Setting.

Pediatric Emergency Care, 2010


Abstract Hyperammonemia is encountered frequently in acutely ill children presenting for emergency care with altered levels of consciousness (ALOC).
Hyperammonemia may be a transient state or may signify more grave etiologies as inborn errors of metabolism.
OBJECTIVES: To determine the level of ammonia in acutely ill children with ALOC, identify causes of hyperammonemia, and correlate levels with illness severity and morbidity.
METHODS: Fifty cases of acutely ill pediatric patients with ALOC who presented to the emergency department were included in the study from 2008 through 2009.
Emergency department patients (n = 20) with known diseases that may induce hyperammonemia were excluded.
Patients were subjected to detailed history taking with emphasis on factors affecting ammonia levels and thorough clinical examination.
RESULTS: The measured blood ammonia level ranged between 13 and 265 μmol/L, with a mean level of 95 μmol/L.
Sixty percent of the children with ALOC had ammonia levels of greater than 75 μmol/L, with levels greater than 200 μmol/L seen in 6% of the studied sample.
The study demonstrated a highly significant statistical difference between children with ALOC and control groups.There was no correlation between blood ammonia level and age.
Correlations of ammonia levels were also conducted in comparison with etiological diagnoses and laboratory parameters with no statistical significance.There was no statistical significance between ammonia level and duration of illness, Sequential Organ Failure Assessment score, or Glasgow Coma Scale score/Morray Scale score.