Case report
Hyperammonemic encephalopathy caused by urinary tract infection with urinary retention

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Introduction

Hyperammonemic encephalopathy can occur as a result of various clinical conditions, such as severe liver diseases, portosystemic shunting, certain drugs, or urea cycle disorders [1]. We report an elderly patient with urinary retention who developed hyperammonemic encephalopathy in association with urinary tract infection (UTI).

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Case report

An 80-year-old female became somnolent and was emergently admitted to our hospital. The patient had a history of urinary retention and recurrent urinary tract infection. She had no history of liver disease.

On admission, her blood pressure was 150/90 mm Hg, and her pulse was 110/min and irregular. Her Glasgow Coma Scale score was 8. There were no focal neurological deficits. The plasma ammonia level was elevated to 151 μg/dl (normal, < 50 μg/dl). Blood tests showed a leukocytosis (10.7 × 109 /l),

Discussion

Our patient's hyperammonemia promptly resolved after antibiotics were given and the urine was drained; this indicates a causal relationship between the UTI and the hyperammonemic encephalopathy.

Although UTI is common in elderly patients with an obstructive uropathy, a UTI is rarely considered as a cause of hyperammonemic encephalopathy. Most of the reported patients with hyperammonemic encephalopathy due to UTI caused by urease-producing bacteria were children who had a congenital anomaly, such

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This study was supported in part by Grants-in-Aid from the Ministry of Health, Labor and Welfare, Japan (H18-Junkanki-044).

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