Hyperammonemic Encephalopathy and Lipid Dysmetabolism in a Critically Ill Patient after A Short Course of Amiodarone
, , , , and | Nov 27, 2019
About this article
Article Category: Case report
Published Online: Nov 27, 2019
Page range: 161 - 165
Received: May 14, 2019
Accepted: Oct 29, 2019
DOI: https://doi.org/10.2478/jccm-2019-0026
Keywords
© 2019 Maximilien Cappe, Philippe Hantson, Mina Komuta, Marie-Françoise Vincent, Pierre- François Laterre, Ismaïl Ould-Nana, published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.
Fig. 1
![(Adapted from [22,23]). Possible mechanisms of amiodarone-induced hypertriglyceridemia and hyperammonemia. Amiodarone is recognized as a potential inhibitor of carnitine-palmityl transferase 1 (CPT1). This will result in a reduced availability of acylcarnitine, with impaired beta-oxidation and acetyl-CoA production. Amiodarone also impairs the mitochondrial respiratory chain activity at the level of complexes I and II. The decrease in acetyl-CoA may also reduce the availability of N-acetyl glutamic acid (NAGA), a substrate for carbamoyl phosphate synthetase (CPS1).](https://sciendo-parsed.s3.eu-central-1.amazonaws.com/64720d53215d2f6c89dba300/j_jccm-2019-0026_fig_001.jpg?X-Amz-Algorithm=AWS4-HMAC-SHA256&X-Amz-Date=20240524T005526Z&X-Amz-SignedHeaders=host&X-Amz-Expires=17999&X-Amz-Credential=AKIA6AP2G7AKP25APDM2%2F20240524%2Feu-central-1%2Fs3%2Faws4_request&X-Amz-Signature=5496f6e8357674b2ab63c8cdfbf3faf29b2fa4560ec0568e9d40f64b7e764431)
List of the medications prescribed over the week preceding amiodarone hydrochloride prescription
| Vancomycin (Mylan, Hoeilaart, Belgium) |
| Ceftazidim (Kefadim®, Eurocept Pharmaceuticals, Ankeeven, The Netherlands) |
| Piperacillin-tazobactam (Mylan, Hoeilaart, Belgium) |
| Amoxicillin (Clamoxyl®, Sandoz, Vilvoorde, Belgium) |
| Metronidazole (B Braun Medical, Diegem, Belgium) |
| Cefuroxime (Zinacef®, GlaxoSmithKline Pharmaceuticals, Wavre, Belgium) |
| Temocillin (Negaban®, Eumedica SA, Manage, Belgium) |
| Insulin (Actrapid®, Novo Nordisk, Brussels, Belgium) |
| Norepinephrine (Aguetant SA/NV, Brussels, Belgium) |
| Nadroparine (Fraxiparine®, Movianto, Aspen, USA) |
Laboratory data before Day 0, and after amiodarone administration
| Day | Day | Day | Day | Day | Day | Day | Day | Day | Day | Day | Day | |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 0 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 | 12 | |
| GGT (NV=<40 IU/L) | 65 | 126 | 305 | 700 | 1172 | 1640 | 1874 | 1507 | 1520 | 1160 | 1267 | 990 |
| Alkaline phosphatase (NV=35-105 IU/L) | 125 | 250 | 369 | 540 | 659 | 734 | 736 | 636 | 626 | 560 | 673 | 549 |
| AST (NV=13-35 IU/L) | 29 | 114 | 80 | 35 | 28 | 23 | 24 | 20 | 22 | 22 | 21 | 17 |
| ALT (NV=7-35 IU/L) | 15 | 19 | 41 | 56 | 57 | 50 | 41 | 40 | 37 | 35 | 37 | 37 |
| Total bilirubin (NV=<1.2 mg/dL) | 0.9 | 1.1 | 1.1 | 1.3 | 1.4 | 1.3 | 1.2 | 1.2 | 1.1 | 0.9 | 0.9 | 0.9 |
| INR (NV=0.80-1.20) | 2.09 | 2.11 | 1.57 | 1.59 | 1.47 | 1.4 | 1.36 | 1.35 | 1.32 | 1.26 | 1.26 | 1.27 |
| Ammonaemia (NV=<90 μg/dL) | - | 179 | 167 | 155 | 139 | 153 | 99 | 79 | 97 | 88 | 111 | 63 |
| Triglycerides (NV=< 150 mg/dL) | - | - | 454 | 438 | 498 | 608 | 604 | - | 444 | 338 | 303 | 223 |
| Arterial lactate (NV=<2.2 mmol/L) | - | 10.4 | 2.9 | 2.0 | 1.3 | 1.4 | 1.9 | 2.0 | 1.5 | 1.4 | 1.9 | 1.9 |
| Urine creatinine) lactate (NV=<50 mmol/mmol | - | 1190 | - | - | - | - | - | - | - | - | - | - |
| Parenteral nutrition | Stop | - | - | - | - | - | - | - | - | - | - | - |
| Enteral nutrition | No | No | 500 ml | No | 500 ml | 500 ml | 500 ml | 500 ml | 500 ml | 500 ml | 500 ml | 500 ml |
| Glucose supplementation | - | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes |