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Severe hyperammoniemia denotes a clinical condition associated with high blood ammonia levels and uncertain prognosis. The presentation can vary with the age of the patient and the magnitude of the...

Background: Valproic acid is an effective drug for controlling seizure in children with epilepsy and it is usually used for treatment as long as two years or more. Blood ammonia level often increased in epileptic children who were treated with long-term valproic acid. The study was conducted to determine the relationship between blood ammonia level with valproic acid therapy in epileptic children. Materials and Methods: This is an observational study with cross-sectional approach. The subjects were 64 children with epilepsy, average age of 6.2 years old. Subjects were 33 boys and 31 girls. Blood ammonia level was examined using enzymatic glutamate dehydrogenase. Subjects were divided into 2 therapeutic groups based on the duration, doses and combination therapy of valproic acid. Subjects were recruited from Pediatric Neurology Clinic, Sanglah General Hospital, Bali, Indonesia, from May to December 2017. Comparison of blood ammonia level between groups were analyzed using an Independent t-test with significances if the p

Urea cycle disorders (UCDs) are one of the most frequently inherited metabolic diseases in Japan, with an estimated prevalence of 1 per 50,000 live births. Here, we investigated the clinical manifestations, treatment, and prognosis of 177 patients with UCDs who were evaluated and treated from January 1999 to March 2009. These included 77 cases of neonatal-onset UCDs and 91 cases of late-onset UCDs. The most common UCD was ornithine transcarbamylase deficiency (OTCD), which accounted for 116 out of 177 patients. This result is similar to a previous study performed between 1978 and 1995 in Japan: OTCD accounted for about two-thirds of the total number of UCD cases. We studied the relationship between prognosis and the peak blood ammonia level at the onset in 151 UCD patients. Compared with a previous survey conducted in Japan, we found that a greater number of patients survived without any mental retardation despite their peak blood ammonia levels being greater than 360 μmol/l. The 5-year survival rate of patients with OTCD improved to 86% for those with the neonatal-onset type and to 92% for those with the late-onset type. We hypothesize that the increased survival rate is due to early diagnosis and better treatments that are now available in Japan. It is very important to diagnose and treat UCDs, especially OTCD, when the blood ammonia levels in patients are low. The outcome in patients with low blood ammonia levels was better than that in patients with high blood ammonia levels.

Laboratory studies have been made to evaluate two methods for removing ammonia from blood:— 1 The twin-coil artificial kidney was found to produce significant reductions in the ammonia content of outdated human banked blood. After one passage through the coil, levels of up to 9 μg. of ammonia nitrogen per millilitre were reduced to normal, and this effect was maintained when up to 5 litres were passed. 2 Ion-exchange resins, in particular a British resin ZK.225 having a 20% divinyl-benzene linkage, were also found to be effective. When passed from an artery directly through an autoclaved resin column to a vein, significant amounts of ammonia were removed from the blood of a dog with pronounced hyperammonaemia. No serious systemic, biochemical, or haematological effects were observed when the blood of three normal dogs was passed through resin columns. All survived, and to date no reason has been found why such a technique could not be used in clinical practice.