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A Journal on Anesthesiology, Resuscitation, Analgesia and Intensive Care

Official Journal of the Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care
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Minerva Anestesiologica 2011 May;77(5):554-7

language: English

Hyperammonemia and neonatal cardiac failure

Adamovic T. 1, Jouvet P. 1, Vobecky S. 2, Garel L. 3, Rougemont A.-L. 4, Alvarez F. 1

1 Department of Pediatrics, Sainte-Justine Hospital, University of Montréal, QC, Montréal, Canada;
2 Department of Surgery, Cardiac Surgery Division, Sainte-Justine Hospital, University of Montréal, Montréal, QC, Canada;
3 Department of Radiology, Sainte-Justine Hospital, University of Montréal, Montréal, QC, Canada;
4 Department of Pathology, Sainte-Justine Hospital, University of Montréal, Montréal, QC, Canada


Severe hyperammonemia (hyperNH3) in neonatal cardiac failure after cardiac surgery is rare. We report a case of a 2470-g female infant born at the week 37 of gestation with complex congenital heart disease (truncus arteriosus type III, interrupted aortic arch and tricuspid valve insufficiency) and hemodynamically non-significant intrahepatic arterio-venous malformation. She developed hyperNH3 (highest NH3 blood level: 467 µmol/L) without severe liver failure (INR of 1.9). The origin of the hyperNH3 was multifactorial including limited capacity of liver detoxification function due to congenital porto-caval shunt, liver ischemia, excessive protein intake and increased protein catabolic rate. HyperNH3 treatment partially succeeded in decreasing ammonia level and included discontinuation of protein intake, administration of phenylacetate and sodium benzoate. This case highlights the fact that NH3 detoxification by the liver has limitations for a neonate with multifactorial causes that decrease liver perfusion.

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