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

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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.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Clinic of General Internal Medicine > Centre of Competence for General Internal Medicine

UniBE Contributor:

Oestmann, Andreas and Aujesky, Drahomir

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0012-0472

Publisher:

Thieme

Language:

German

Submitter:

Patricia Rajaonina

Date Deposited:

05 Feb 2015 09:44

Last Modified:

05 Feb 2015 09:44

Publisher DOI:

10.1055/s-0034-1370132

PubMed ID:

25072861

BORIS DOI:

10.7892/boris.62475

URI:

https://boris.unibe.ch/id/eprint/62475

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