Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Case Report
  • Published:

Hyperammonemia after high-dose chemotherapy and stem cell transplantation

Bone Marrow Transplantation volume 26, pages 343–345 (2000)Cite this article

Abstract

We report a patient with multiple myeloma who suffered from hyperammonemia after a second stem cell autograft. This syndrome is not well known but is associated with a high mortality rate. Considering the possibility of this diagnosis in patients developing confusion and neurological degradation with respiratory alkalosis after intensive chemotherapy, could allow earlier treatment and perhaps improved survival. Possible mechanisms and potential therapies are discussed. With rapid recognition and treatment of the syndrome, the patient fully recovered. One and a half years later, she is still alive and well, on interferon for persisting myeloma. Bone Marrow Transplantation (2000) 26, 343–345.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  1. Mitchell RB, Wagner JE, Karp JE et al. Syndrome of idiopathic hyperammonemia after high-dose chemotherapy: review of nine cases Am J Med 1988 85: 662–667

    Article  CAS  Google Scholar 

  2. Davies SM, Szabo E, Wagner JE et al. Idiopathic hyperammonemia: a frequently lethal complication of bone marrow transplantation Bone Marrow Transplant 1996 17: 1119–1125

    CAS  PubMed  Google Scholar 

  3. Leonard JV, Kay JDS . Acute encephalopathy and hyperammonaemia complicating treatment of acute lymphoblastic leukaemia with asparaginase Lancet 1986 i: 162–163

    Article  Google Scholar 

  4. Shi-Rong X, Er-Gu Y, Zuo-Ren D et al. Plasma ammonia in patients with acute leukemia Chin Med J 1992 105: 713–716

    Google Scholar 

  5. Jürgens P . New aspects on etiology, biochemistry, and therapy of portal systemic encephalopathy: a critical survey Nutrition 1997 13: 560–570

    Article  Google Scholar 

  6. Watson AJ, Chambers T, Karp JE et al. Transient idiopathic hyperammonaemia in adults Lancet 1985 ii: 1271

    Article  Google Scholar 

  7. Felig DM, Brusilow SW, Boyer JL . Hyperammonemic coma due to parenteral nutrition in a woman with heterozygous ornithine transcarbamylase deficiency Gastroenterology 1995 109: 282–284

    Article  CAS  Google Scholar 

  8. Sharp RA, Lang CC . Hyperammonaemic encephalopathy in chronic myelomonocytic leukemia Lancet 1987 i: 805

    Article  Google Scholar 

  9. Butterworth RF, Giguere JF, Michaud J et al. Ammonia: key factor in the pathogenesis of hepatic encephalopathy Neurochem Pathol 1987 6: 1–12

    Article  CAS  Google Scholar 

  10. Felipo V, Hermenegildo C, Montolin C et al. Neurotoxicity of ammonia and glutamate: molecular mechanisms and prevention Neurotoxicology 1998 19: 675–681

    CAS  PubMed  Google Scholar 

  11. Tse N, Cederbaum S, Glaspy JA . Hyperammonemia following allogeneic bone marrow transplantation Am J Hematol 1991 38: 140–141

    Article  CAS  Google Scholar 

  12. Oppong KNW, Al-Mardini H, Thick M, Record CO . Oral glutamine challenge in cirrhotics pre- and post-liver transplantation: a psychometric and analyzed EEG study Hepatology 1997 26: 870–876

    Article  CAS  Google Scholar 

  13. Semana DS, Huet F, Gouyon J-B et al. Use of peritoneal dialysis, continuous arteriovenous hemofiltration, and continuous arteriovenous hemodiafiltration for removal of ammonium chloride and glutamine in rabbits J Pediatr 1995 126: 742–746

    Article  Google Scholar 

  14. Therrien G, Rose C, Butterworth J, Butterworth RF . Protective effect of L-carnitine in ammonia-precipitated encephalopathy in the portacaval shunted rat Hepatology 1997 25: 551–556

    Article  CAS  Google Scholar 

  15. Beversdorf D, Allen C, Nordgren R . Valproate induced encephalopathy treated with carnitine in an adult J Neuro Neurosurg Psych 1996 61: 211

    Article  CAS  Google Scholar 

  16. Meier R, Gyr K . Treatment of hepatic encephalopathy (HE) with the benzodiazepine antagonist flumazenil: a pilot study Eur J Anaesth 1988 S2: 139–146

    Google Scholar 

  17. Schafer DF, Jones EA . Hepatic encephalopathy and theγ-aminobutyric-acid neurotransmitter system Lancet 1982 i: 18–20

    Article  Google Scholar 

  18. Mullen KD, Martin JV, Mendelson WB et al. Could an endogenous benzodiazepine ligand contribute to hepatic encephalopathy? Lancet 1988 i: 457–459

    Article  Google Scholar 

  19. Pomier-Layrargues G, Giguère JF, Lavoie J et al. Flumazenil in cirrhotic patients in hepatic coma: a randomized double-blind placebo-controlled crossover trial Hepatology 1997 19: 32–37

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Medicine, Division of Hematology, Division of Intensive Care, University of Liège, Liège, Belgium

    P Frere, C Gennigens, G Fillet & Y Beguin

  2. Department of Anesthesiology, Division of Intensive Care, University of Liège, Liège, Belgium

    JL Canivet & JP Rebeix

Authors
  1. P Frere
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. JL Canivet
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. C Gennigens
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. JP Rebeix
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. G Fillet
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Y Beguin
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Frere, P., Canivet, J., Gennigens, C. et al. Hyperammonemia after high-dose chemotherapy and stem cell transplantation. Bone Marrow Transplant 26, 343–345 (2000). https://doi.org/10.1038/sj.bmt.1702485

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.bmt.1702485

Keywords

This article is cited by

Search

Advanced search

Quick links