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Hyperammonemia During Total Parenteral Nutrition in Children
Author(s) -
Seashore John H.,
Seashore Margretta R.,
Riely Caroline
Publication year - 1982
Publication title -
journal of parenteral and enteral nutrition
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.935
H-Index - 98
eISSN - 1941-2444
pISSN - 0148-6071
DOI - 10.1177/0148607182006002114
Subject(s) - hyperammonemia , medicine , parenteral nutrition , arginine , incidence (geometry) , gastroenterology , pediatrics , endocrinology , amino acid , biochemistry , biology , physics , optics
Serial blood ammonia (NH 3 ) determinations in 19 low birth weight (LBW) infants, 14 term neonates and 12 children receiving total parenteral nutrition (TPN) have shown that 73% of patients had one or more elevated NH 3 values (>150 μg/dl). The mean blood NH3 was 220 ± 13 μg/dl in LBW infants, 180 ± 9 ug/dl in 10 infants, and 140 ± 7 μg/dl in children. All of these values are significantly higher than normal (p < 0.001). There was no difference in incidence or mean blood ammonia concentration between patients receiving casein hydrolysate and those receiving a crystalline amino acid solution. Only four patients were symptomatic and several infants remained fully alert despite blood NH 3 concentration in excess of 400 μg/dl. One infant who had sustained hyperammonemia was given another amino acid source (Travasol) containing 1.2 mmol/dl of arginine; blood NH3 promptly fell to the normal range. However, six of seven additional infants had hyperammonemia while receiving Travasol (mean = 184 μg/dl). Hyperammonemia is common during TPN in children, often is not recognized clinically, and occurs with equal frequency in infants and older children. The high levels observed in LBW infants may be due to hepatic immaturity. Blood NH3 concentration should be monitored frequently during TPN. Persistent hyperammonemia should be treated by decreasing protein content of the infusate. The role of supplemental arginine is unclear.