Indian Journal of Critical Care Medicine

Register      Login



Volume / Issue

Online First

Related articles

VOLUME 25 , ISSUE 5 ( May, 2021 ) > List of Articles


Hyperammonemia after Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy: A Report of Three Cases with Unusual Presentation

Vivekanand Sharma, Sohan Lal Solanki, Avanish P Saklani

Citation Information : Sharma V, Solanki SL, Saklani AP. Hyperammonemia after Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy: A Report of Three Cases with Unusual Presentation. Indian J Crit Care Med 2021; 25 (5):590-593.

DOI: 10.5005/jp-journals-10071-23821

License: CC BY-NC 4.0

Published Online: 01-05-2021

Copyright Statement:  Copyright © 2021; The Author(s).


Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is a treatment modality for peritoneal surface malignancies. A variety of metabolic derangements have been reported in the perioperative period in these patients, most of which are a result of the complex interaction of peritoneal denudation, chemotherapy bath, and fluid imbalance. We report three cases of hyperammonemia-related neurological dysfunction seen in HIPEC patients. To the best of our knowledge, this is the first report of this presentation. Timely recognition of this condition needs a high degree of suspicion, and unless aggressively treated, is likely to be associated with poor outcome.

  1. Solanki SL, Mukherjee S, Agarwal V, Thota RS, Balakrishnan K, Shah SB, et al. Society of onco-anaesthesia and perioperative care consensus guidelines for perioperative management of patients for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC). Indian J Anaesth 2019;63:972–987. DOI: 10.4103/ija.IJA_765_19.
  2. Solanki SL, Jhingan MAK, Saklani AP. Rebound hypothermia after cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) and cardiac arrest in immediate postoperative period: a report of two cases and review of literature. Pleura Peritoneum 2020;5:20200126. DOI: 10.1515/pp-2020-0126.
  3. Mallet M, Weiss N, Thabut D, Rudler M. Why and when to measure ammonemia in cirrhosis? Clin Res Hepatol Gastroenterol 2018;42:505–511. DOI: 10.1016/j.clinre.2018.01.004.
  4. Clay AS, Hainline BE. Hyperammonemia in the ICU. Chest 2007;132:1368–1378. DOI: 10.1378/chest.06-2940.
  5. Nakamura T, Shibata S, Miyatani Y, et al. Hyperammonemia with impaired consciousness caused by continuous 5-fluorouracil infusion for colorectal cancer: a case report. Int J Clin Pharmacol Ther 2020;58(12):727–731. DOI: 10.5414/CP203762.
  6. Yanagawa Y, Nishi K, Sakamoto T. Hyperammonemia is associated with generalized convulsion. Intern Med 2008;47:21–23. DOI: 10.2169/internalmedicine.47.0482.
  7. Kalra A, Norvell JP. Cause for confusion: noncirrhotic hyperammonemic encephalopathy. Clin Liver Dis 2020;15:223–227. DOI: 10.1002/cld.929.
  8. Upadhyay R, Bleck TP, Busl KM. Hyperammonemia: what urea-lly need to know: case report of severe noncirrhotic hyperammonemic encephalopathy and review of the literature. Case Rep Med 2016;2016:8512721. DOI: 10.1155/2016/8512721.
  9. Labib PLZ, Wing S, Bhowmik A. Transient hyperammonaemia in a patient with confusion: challenges with the differential diagnosis. Case Rep 2011;2011:bcr0320113961. DOI: 10.1136/bcr.03.2011.3961.
  10. Lee YL, Pang S, Ong C. Non-cirrhotic hyperammonaemia: are we missing the diagnosis? BMJ Case Rep 2020;13:e233218. DOI: 10.1136/bcr-2019-233218.
  11. Hawkes ND, Thomas GA, Jurewicz A, Williams OM, Hillier CE, McQueen IN, et al. Non-hepatic hyperammonaemia: an important, potentially reversible cause of encephalopathy. Postgrad Med J 2001;77(913):717–722. DOI: 10.1136/pmj.77.913.717.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.