Hyperammonemic encephalopathy in multiple myeloma

Oestmann, Andreas; Aujesky, Drahomir (2014). Hyperammonemic encephalopathy in multiple myeloma. Deutsche medizinische Wochenschrift, 139(30), pp. 1518-1520. Thieme 10.1055/s-0034-1370132

Preview

Text s-0034-1370132.pdf - Published Version Available under License Publisher holds Copyright. Download (144kB) | Preview

HISTORY AND CLINICAL FINDINGS

A 54-year old man had suffered from advanced multiple myeloma for two years. After initially good response the myeloma was refractrory to treatment with dexamethasone, cyclophosphamide, bortezomibe, zoledronate and additionally doxorubicine. The patient then complained of dyspnea without clinical signs of cardiopulmonary disease.

INVESTIGATIONS

Arterial blood gas analysis showed hyperventilation with respiratory alkalosis and normal alveolo-arterial gradient as the reason for the dyspnea. With a normal MRI of the brain and lumbal puncture, a neurological disease could be excluded. Serum calcium, creatinine and serum viscosity were normal. Eventually, serum ammonia levels were found to be substantially elevated (144 µmol/l) and hyperammonemic encephalopathy was diagnosed.

TREATMENT AND COURSE

Therapy with bortezomib and high dose dexamethason was repeated, and the patient also received bendamustin. Despite this treatment, he lost consciousness and died after two weeks because of aspiration pneumonia.

CONCLUSION

The existence of respiratory alkalosis and multiple myeloma should prompt a search for hyperammonemia.

Interest & Impact

Downloads

830 since deposited on 05 Feb 2015
117 in the past 12 months

Citations

5 Citations in Web of Science ®
6 Citations in Scopus

Search

in Google Scholar™

Services

Actions (login required)

Edit item

Actions (login required)

Edit item