{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,17]],"date-time":"2026-01-17T09:06:33Z","timestamp":1768640793615,"version":"3.49.0"},"reference-count":9,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Reports"],"accepted":{"date-parts":[[2017,8,7]]},"abstract":"<jats:p>A 59-year-old woman who underwent an uncomplicated exploratory laparotomy, adhesiolysis, small bowel resection and anterolateral thigh flap had a complicated postoperative period characterised by wound dehiscence and poor nutritional intake. 29 days postoperatively, a tremor developed in her upper limbs associated with weakness. Her Glasgow Coma Scale (GCS) fell to 4 and she was transferred to the intensive care unit. The patient was reviewed by multiple specialists and multiple differentials were considered and eliminated. Eventually, investigations revealed hyperammonaemic encephalopathy, being a result of low arginine and potentially small intestinal bacterial overgrowth. Following treatment with sodium benzoate, sodium phenylbutyrate and arginine along with haemodialysis and rifaximin, GCS and hyperammonaemia rapidly improved. She was stepped down to surgical high-dependency unit, continued arginine therapy with total parenteral nutrition and percutaneous endoscopic gastrostomy feeds. She was discharged with regular follow-up from surgeons and biochemistry and continues oral arginine therapy.<\/jats:p>","DOI":"10.1136\/bcr-2017-221458","type":"journal-article","created":{"date-parts":[[2017,8,16]],"date-time":"2017-08-16T07:39:24Z","timestamp":1502869164000},"page":"bcr-2017-221458","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":5,"title":["Hyperammonaemic encephalopathy following an uncomplicated surgery"],"prefix":"10.1136","volume":"2017","author":[{"given":"Stuart","family":"McIntosh","sequence":"first","affiliation":[{"name":"Plastic Surgery Department, NHS Grampian, Aberdeen, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karima","family":"Medjoub","sequence":"additional","affiliation":[{"name":"Plastic Surgery Department, NHS Grampian, Aberdeen, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kevin","family":"Deans","sequence":"additional","affiliation":[{"name":"Department of Biochemistry, NHS Grampian, Aberdeen, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sara","family":"Sexton","sequence":"additional","affiliation":[{"name":"Plastic Surgery Department, NHS Grampian, Aberdeen, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2017,8,16]]},"reference":[{"key":"2025082723483423000_2017.aug16_1.bcr-2017-221458.1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.06-2940"},{"key":"2025082723483423000_2017.aug16_1.bcr-2017-221458.2","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1186\/2052-0492-2-22","article-title":"Hyperammonemia due to urea cycle disorders: a potentially fatal condition in the intensive care setting","volume":"2","author":"Machado","year":"2014","journal-title":"J Intensive Care"},{"key":"2025082723483423000_2017.aug16_1.bcr-2017-221458.3","doi-asserted-by":"crossref","first-page":"S29","DOI":"10.1016\/j.jceh.2014.12.003","article-title":"Gut microbiota: its role in hepatic encephalopathy","volume":"5","author":"Rai","year":"2015","journal-title":"J Clin Exp Hepatol"},{"key":"2025082723483423000_2017.aug16_1.bcr-2017-221458.4","first-page":"112","article-title":"Small intestinal bacterial overgrowth: a comprehensive review","volume":"3","author":"Dukowicz","year":"2007","journal-title":"Gastroenterol Hepatol"},{"key":"2025082723483423000_2017.aug16_1.bcr-2017-221458.5","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1002\/cld.445","article-title":"Pathophysiological mechanisms of hepatic encephalopathy","volume":"5","author":"Tranah","year":"2015","journal-title":"Clin Liver Dis"},{"key":"2025082723483423000_2017.aug16_1.bcr-2017-221458.6","doi-asserted-by":"publisher","DOI":"10.1002\/hep.21357"},{"key":"2025082723483423000_2017.aug16_1.bcr-2017-221458.7","doi-asserted-by":"publisher","DOI":"10.1136\/pmj.77.913.717"},{"key":"2025082723483423000_2017.aug16_1.bcr-2017-221458.8","doi-asserted-by":"crossref","first-page":"2461.e3","DOI":"10.1016\/j.ajem.2016.05.065","article-title":"Cerebral edema induced by hyperammonemia: a case report","volume":"34","author":"Yonai","year":"2016","journal-title":"Am J Emerg Med"},{"key":"2025082723483423000_2017.aug16_1.bcr-2017-221458.9","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1038\/ejcn.2014.244","article-title":"Refeeding encephalopathy in a patient with severe hypophosphataemia and hyperammonaemia","volume":"69","author":"Becker","year":"2015","journal-title":"Eur J Clin Nutr"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2017-221458","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T06:48:43Z","timestamp":1756363723000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2017-221458"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,8,16]]},"references-count":9,"alternative-id":["10.1136\/bcr-2017-221458"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2017-221458","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,8,16]]}}}