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Hyperammonemic Encephalopathy and Lipid Dysmetabolism in a Critically Ill Patient after A Short Course of Amiodarone

Maximilien Cappe

Maximilien Cappe

Department of Intensive Care, Cliniques St-Luc, Université catholique de LouvainBrussels, Belgium
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Cappe, Maximilien
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Philippe Hantson

Philippe Hantson

Department of Intensive Care, Cliniques St-Luc, Université catholique de LouvainBrussels, Belgium
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Hantson, Philippe
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Mina Komuta

Mina Komuta

Department of Pathology, Cliniques St-Luc, Université catholique de LouvainBrussels, Belgium
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Komuta, Mina
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Marie-Françoise Vincent

Marie-Françoise Vincent

Department of Clinical Chemistry, Cliniques St-Luc, Université catholique de LouvainBrussels, Belgium
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Vincent, Marie-Françoise
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Pierre-François Laterre

Pierre-François Laterre

Department of Intensive Care, Cliniques St-Luc, Université catholique de LouvainBrussels, Belgium
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Laterre, Pierre-François
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Ismaïl Ould-Nana

Ismaïl Ould-Nana

Department of Intensive Care, Cliniques St-Luc, Université catholique de LouvainBrussels, Belgium
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Ould-Nana, Ismaïl
  
27 nov 2019
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Categoria dell'articolo: Case report
Pubblicato online: 27 nov 2019
Pagine: 161 - 165
Ricevuto: 14 mag 2019
Accettato: 29 ott 2019
DOI: https://doi.org/10.2478/jccm-2019-0026
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© 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).
(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).

List of the medications prescribed over the week preceding amiodarone hydrochloride prescription

Medications
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

DayDayDayDayDayDayDayDayDayDayDayDay
023456789101112
GGT (NV=<40 IU/L)651263057001172164018741507152011601267990
Alkaline phosphatase (NV=35-105 IU/L)125250369540659734736636626560673549
AST (NV=13-35 IU/L)2911480352823242022222117
ALT (NV=7-35 IU/L)151941565750414037353737
Total bilirubin (NV=<1.2 mg/dL)0.91.11.11.31.41.31.21.21.10.90.90.9
INR (NV=0.80-1.20)2.092.111.571.591.471.41.361.351.321.261.261.27
Ammonaemia (NV=<90 μg/dL)-1791671551391539979978811163
Triglycerides (NV=< 150 mg/dL)--454438498608604-444338303223
Arterial lactate (NV=<2.2 mmol/L)-10.42.92.01.31.41.92.01.51.41.91.9
Urine creatinine) lactate (NV=<50 mmol/mmol-1190----------
Parenteral nutritionStop-----------
Enteral nutritionNoNo500 mlNo500 ml500 ml500 ml500 ml500 ml500 ml500 ml500 ml
Glucose supplementation-YesYesYesYesYesYesYesYesYesYesYes
Lingua:
Inglese
Frequenza di pubblicazione:
4 volte all'anno
Argomenti della rivista:
Medicina, Medicina clinica, Medicina interna, Medicina interna, altro, Chirurgia, Chirurgia, altro, Anestesiologia, Medicina d'urgenza e medicina di terapia intensiva
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