{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,2]],"date-time":"2026-03-02T10:03:25Z","timestamp":1772445805156,"version":"3.50.1"},"reference-count":14,"publisher":"Springer Science and Business Media LLC","issue":"4","license":[{"start":{"date-parts":[[2025,10,16]],"date-time":"2025-10-16T00:00:00Z","timestamp":1760572800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,10,16]],"date-time":"2025-10-16T00:00:00Z","timestamp":1760572800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100017540","name":"NHLBI Division of Intramural Research","doi-asserted-by":"publisher","award":["K23 HL168362"],"award-info":[{"award-number":["K23 HL168362"]}],"id":[{"id":"10.13039\/100017540","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Pediatr Nephrol"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Kidney replacement therapy (KRT) is commonly used to treat critically ill children for a variety of reasons, including hyperammonemia. KRT management in children with hyperammonemia not due to inborn errors of metabolism is challenging.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>We report a complex case of hyperammonemia in a 17-year-old critically ill female patient, emphasizing the challenges of management in a pediatric intensive care setting. Despite the initiation of kidney replacement therapy (KRT) and progressive increases in the prescribed dialytic dose, the patient\u2019s ammonia levels continued to escalate. This prompted a reevaluation of her metabolic needs, with a focus on optimizing glucose delivery to facilitate ammonia metabolism and dialytic clearance. Adjustments to increase the delivered glucose, along with careful monitoring of glucose removal during KRT, ultimately led to the stabilization of her ammonia levels.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This case underscores the intricate interplay between metabolic support and dialytic strategies in the management of hyperammonemia. The use of a glucose delivery calculator is proposed. This case highlights the need for individualized, dynamic approaches in critically ill pediatric patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00467-025-07006-7","type":"journal-article","created":{"date-parts":[[2025,10,16]],"date-time":"2025-10-16T21:23:59Z","timestamp":1760649839000},"page":"1213-1219","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["\u201cWhy won\u2019t the ammonia go down?\u201d: ammonia management while on continuous kidney replacement therapy"],"prefix":"10.1007","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9412-8950","authenticated-orcid":false,"given":"Michelle C.","family":"Starr","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jason","family":"Burnham","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michelle","family":"Voivoidas","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amy","family":"Wilson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,10,16]]},"reference":[{"key":"7006_CR1","doi-asserted-by":"publisher","first-page":"753","DOI":"10.1007\/s00467-019-04213-x","volume":"35","author":"L de Galasso","year":"2020","unstructured":"de Galasso L, Picca S, Guzzo I (2020) Dialysis modalities for the management of pediatric acute kidney injury. 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Pediatr Nephrol 27:207\u2013222","journal-title":"Pediatr Nephrol"},{"key":"7006_CR7","doi-asserted-by":"publisher","DOI":"10.3390\/nu14132755","volume":"14","author":"A B\u00e9langer-Quintana","year":"2022","unstructured":"B\u00e9langer-Quintana A, Arrieta Blanco F, Barrio-Carreras D, Bergua Mart\u00ednez A, Ca\u00f1edo Villarroya E, Garc\u00eda-Silva MT, Lama More R, Mart\u00edn-Hern\u00e1ndez E, L\u00f3pez AM, Morales-Conejo M, Pedr\u00f3n-Giner C, Quijada-Fraile P, Stanescu S, Casanova MM (2022) Recommendations for the diagnosis and therapeutic management of hyperammonaemia in paediatric and adult patients. Nutrients 14:2755","journal-title":"Nutrients"},{"key":"7006_CR8","doi-asserted-by":"publisher","first-page":"1872","DOI":"10.2215\/CJN.01320216","volume":"11","author":"S Gupta","year":"2016","unstructured":"Gupta S, Fenves AZ, Hootkins R (2016) The role of RRT in hyperammonemic patients. 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For full disclosure, we provide here an additional list of authors\u2019 other commitments and funding sources that are not directly related to this study: Michelle C. Starr receives funding from the National Institutes of Health (NIDDK and NHLBI).","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"None.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Prior presentation of study data"}}]}}