{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T01:30:16Z","timestamp":1760059816462,"version":"build-2065373602"},"reference-count":10,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2025,7,14]],"date-time":"2025-07-14T00:00:00Z","timestamp":1752451200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Reports"],"abstract":"<jats:p>Background and clinical significance: Acute reduction in vigilance is a frequent reason for emergency department admissions, especially among the elderly. While intracranial causes or infections with fluid depletion are often responsible, there remain cases where imaging, laboratory tests, and clinical examination fail to provide a clear diagnosis. Case presentation: A 91-year-old woman was presented to the emergency department with recurrent episodes of somnolence to deep coma. On admission, her vital signs were stable, and cerebral CT imaging revealed no intracranial pathology. Laboratory analyses, including blood gas measurements, were unremarkable. Empirical treatment for possible intoxications with benzodiazepines or opioids using flumazenil and naloxone had no effect. An Addison\u2019s crisis was considered but excluded following methylprednisolone administration without improvement in consciousness. Eventually, an isolated elevation of serum ammonia was identified as the cause of the reduced vigilance. Further investigation linked the hyperammonemia to abnormal intestinal bacterial colonization, likely due to a prior ureteroenterostomy. There was no evidence of liver dysfunction, thus classifying the condition as non-hepatic hyperammonemia. Therapy was initiated with rifaximin, supported by aggressive laxative regimens. Ammonia levels and vital parameters were closely monitored. The patient\u2019s condition improved gradually, with serum ammonia levels returning to normal and cognitive function fully restored. Conclusions: This case highlights an uncommon cause of coma due to non-hepatic hyperammonemia in the absence of liver disease, emphasizing the diagnostic challenge when standard evaluations are inconclusive. It underscores the need for broad differential thinking in emergency settings and the importance of considering rare metabolic disturbances as potential causes of altered mental status.<\/jats:p>","DOI":"10.3390\/reports8030107","type":"journal-article","created":{"date-parts":[[2025,7,14]],"date-time":"2025-07-14T07:54:23Z","timestamp":1752479663000},"page":"107","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A 91-Year-Old Female with Recurring Coma Due to Atypical Hyperammonemia"],"prefix":"10.3390","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-9547-0835","authenticated-orcid":false,"given":"Manuel","family":"Reichert","sequence":"first","affiliation":[{"name":"Department of Internal Medicine II, City Hospital (St\u00e4dtisches Klinikum), 38118 Braunschweig, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,7,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"318","DOI":"10.1186\/s13256-021-02842-1","article-title":"Recurrent noncirrhotic hyperammonemia causing acute metabolic encephalopathy in a patient with a continent ileocecal pouch: A case report","volume":"15","author":"Skipina","year":"2021","journal-title":"J. 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Gastroenterol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"8512721","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":"ref_7","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1177\/1756283X11401774","article-title":"Rifaximin treatment for reduction of risk of overt hepatic encephalopathy recurrence","volume":"4","author":"Flamm","year":"2011","journal-title":"Ther. Adv. Gastroenterol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1111\/jgh.14408","article-title":"Mechanistic insight, diagnosis, and treatment of ammonia-induced hepatic encephalopathy","volume":"34","author":"Song","year":"2019","journal-title":"J. Gastroenterol. Hepatol."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Kim, K., Jeon, J., Jung, C., Park, J., Seo, J., and Kwon, D. (2022). Etiologies of altered level of consciousness in the emergency room. Sci. Rep., 12.","DOI":"10.1038\/s41598-022-09110-2"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2064","DOI":"10.1016\/S0140-6736(13)62184-4","article-title":"Diagnosis of reversible causes of coma","volume":"384","author":"Edlow","year":"2014","journal-title":"Lancet"}],"container-title":["Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2571-841X\/8\/3\/107\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:09:26Z","timestamp":1760033366000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2571-841X\/8\/3\/107"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,14]]},"references-count":10,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2025,9]]}},"alternative-id":["reports8030107"],"URL":"https:\/\/doi.org\/10.3390\/reports8030107","relation":{},"ISSN":["2571-841X"],"issn-type":[{"type":"electronic","value":"2571-841X"}],"subject":[],"published":{"date-parts":[[2025,7,14]]}}}