{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,29]],"date-time":"2025-08-29T10:15:59Z","timestamp":1756462559734,"version":"3.44.0"},"reference-count":14,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Reports"],"accepted":{"date-parts":[[2018,2,16]]},"abstract":"<jats:p>A 51-year-old female presented with acute confusion associated with a non-specific headache and lethargy. The patient\u2019s history included bipolar disorder on valproate and recent travel to northern Vietnam. The patient was subsequently found to have hyperammonaemia as well as a urinary tract infection and bacteraemia with <jats:italic>Klebsiellapneumoniae<\/jats:italic>. The patient was presumed to have a multifactorial non-cirrhotic hyperammonaemic encephalopathy due to a combination of a urinary tract infection and bacteraemia with <jats:italic>K. pneumoniae<\/jats:italic>, a urease-producing bacteria, and also valproate use, a medication known to interfere with ammonia elimination. The patient\u2019s treatment included supportive care, ceasing valproate, empiric then rationalised antibiotics, N-acetylcysteine and L-carnitine. We present a case of non-cirrhotic hyperammonaemic encephalopathy and explain why it is multifactorial in origin.<\/jats:p>","DOI":"10.1136\/bcr-2017-223245","type":"journal-article","created":{"date-parts":[[2018,3,9]],"date-time":"2018-03-09T04:10:28Z","timestamp":1520568628000},"page":"bcr-2017-223245","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":7,"title":["Multifactorial non-cirrhotic hyperammonaemic encephalopathy"],"prefix":"10.1136","volume":"2018","author":[{"given":"Katherine Elizabeth","family":"Triplett","sequence":"first","affiliation":[{"name":"Intensive Care, Sir Charles Gairdner Hospital, Nedlands, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ronan","family":"Murray","sequence":"additional","affiliation":[{"name":"Infectious Diseases and PathWest Laboratory Medicine, Sir Charles Gairdner Hospital, Nedlands, Australia"},{"name":"School of Pathology and Laboratory Medicine, University of Western Australia, Nedlands, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthew","family":"Anstey","sequence":"additional","affiliation":[{"name":"Intensive Care, Sir Charles Gairdner Hospital, Nedlands, Australia"},{"name":"School of Medicine and Pharmacology, University of Western Australia, Nedlands, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2018,3,9]]},"reference":[{"key":"2025082804350031000_2018.mar08_2.bcr-2017-223245.1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cit458"},{"key":"2025082804350031000_2018.mar08_2.bcr-2017-223245.2","doi-asserted-by":"crossref","first-page":"1216","DOI":"10.1016\/j.jhep.2015.01.009","article-title":"Hyperammonemia in ICU patients: a frequent finding associated with high mortality","volume":"62","author":"Prado","year":"2015","journal-title":"J Hepatol"},{"key":"2025082804350031000_2018.mar08_2.bcr-2017-223245.3","doi-asserted-by":"crossref","first-page":"713","DOI":"10.1007\/s11064-016-2014-x","article-title":"Neurotoxicity of Ammonia","volume":"42","author":"Oja","year":"2017","journal-title":"Neurochem Res"},{"key":"2025082804350031000_2018.mar08_2.bcr-2017-223245.4","doi-asserted-by":"crossref","first-page":"1259","DOI":"10.1111\/j.1478-3231.2011.02550.x","article-title":"Noncirrhotic hyperammonaemic encephalopathy","volume":"31","author":"Laish","year":"2011","journal-title":"Liver Int"},{"key":"2025082804350031000_2018.mar08_2.bcr-2017-223245.5","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1155\/2016\/8512721","article-title":"Hyperammonemia: What Urea-lly Need to Know: Case Report of Severe Noncirrhotic Hyperammonemic Encephalopathy and Review of the Literature","volume":"2016","author":"Upadhyay","year":"2016","journal-title":"Case Rep Med"},{"key":"2025082804350031000_2018.mar08_2.bcr-2017-223245.6","doi-asserted-by":"crossref","first-page":"e0136220","DOI":"10.1371\/journal.pone.0136220","article-title":"Hyperammonemia in Urinary Tract Infections","volume":"10","author":"Kenzaka","year":"2015","journal-title":"PLoS One"},{"key":"2025082804350031000_2018.mar08_2.bcr-2017-223245.7","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejim.2007.10.022"},{"key":"2025082804350031000_2018.mar08_2.bcr-2017-223245.8","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(02)11084-1"},{"key":"2025082804350031000_2018.mar08_2.bcr-2017-223245.9","doi-asserted-by":"publisher","DOI":"10.1007\/s004670050523"},{"key":"2025082804350031000_2018.mar08_2.bcr-2017-223245.10","doi-asserted-by":"publisher","DOI":"10.1016\/j.genhosppsych.2011.12.009"},{"key":"2025082804350031000_2018.mar08_2.bcr-2017-223245.11","doi-asserted-by":"crossref","first-page":"2017","DOI":"10.1007\/s10072-016-2673-z","article-title":"A case with hyperammonemic encephalopathy triggered by single dose valproate","volume":"37","author":"Ciftci","year":"2016","journal-title":"Neurol Sci"},{"key":"2025082804350031000_2018.mar08_2.bcr-2017-223245.12","doi-asserted-by":"publisher","DOI":"10.1080\/15563650902752376"},{"key":"2025082804350031000_2018.mar08_2.bcr-2017-223245.13","doi-asserted-by":"crossref","first-page":"2330","DOI":"10.1007\/s10620-007-0183-9","article-title":"Is oral L-acyl-carnitine an effective therapy for hepatic encephalopathy? 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