Hyperammonemic syndrome after Roux-en-Y gastric bypass

Obesity
Andrew FenvesAnkit Mehta

Abstract

Hyperammonemic encephalopathy is an uncommon but severe complication of the Roux-en-Y gastric bypass surgery for obesity. Mechanisms underlying this complication are incompletely understood, resulting in delayed recognition and management. This study evaluated common laboratory findings and possible etiology of hyperammonemic encephalopathy after successful Roux-en-Y gastric bypass surgery. A retrospective review of 20 patients identified through our own clinical practice was conducted, with the addition of similar cases from other institutions identified through the review of literature. Patients presenting with hyperammonemic encephalopathy after Roux-en-Y gastric bypass surgery presented with overlapping clinical and laboratory findings. Common features included: (1) weight loss following successful Roux-en-Y gastric bypass for obesity; (2) hyperammonemic encephalopathy accompanied by elevated plasma glutamine levels; (3) absence of cirrhosis; (4) hypoalbuminemia; and (5) low plasma zinc levels. The mortality rate was 50%. Ninety-five percent of patients were women. Three patients were diagnosed with proximal urea cycle disorders. One patient experienced improvement in the hyperammonemia after surgical correction of spontane...Continue Reading

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Citations

May 5, 2016·Case Reports in Critical Care·Gyanendra AcharyaHarmanjot Kaur
Jul 10, 2018·Critical Care Medicine·Amra SakusicOgnjen Gajic
Mar 20, 2019·The Kaohsiung Journal of Medical Sciences·Yen-Hsien WuZen-Kong Dai
Jul 28, 2019·American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons·George Z LiAndrew B Stergachis
Jul 3, 2019·Obesity Surgery·Carlijn KuinHans de Boer
Jul 28, 2020·Journal of Inherited Metabolic Disease·Andrew B StergachisJoel B Krier
Oct 18, 2019·ACG Case Reports Journal·Janyll CastineiraBasem Alkurdi
Jan 28, 2017·Proceedings·Amulya Nagarur, Andrew Z Fenves
May 26, 2018·Obesity Surgery·Patrick C Bonasso, Melvin S Dassinger
Jul 30, 2019·Case Reports in Gastrointestinal Medicine·Juan D SalcedoMaria Antonietta Mosetti
Apr 15, 2017·Molecular Genetics and Metabolism·Anne H O'Donnell-LuriaNatasha Y Frank
Mar 26, 2021·Molecular Genetics and Metabolism Reports·Andrew B StergachisAlexander P Lin
Apr 4, 2021·The American Journal of Medicine·Richa SharmaAmit Gupta

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