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Background <p>Hyperammonemia is a rare but serious cause of encephalopathy, commonly associated with hepatic dysfunction. However, non-hepatic hyperammonemia (NHHA) can arise due to impaired gastrointestinal transit, urease-producing organisms, and metabolic disorders. We present a case of NHHA following coronary artery bypass grafting (CABG).</p> Case presentation <p>A 56-year-old male with chronic alcohol use developed post-operative ileus and altered mental status on post-operative day 5 after an uncomplicated CABG. Despite normal liver function, ammonia levels peaked at 256 µmol/L. Given ileus, conventional therapy was deferred and continuous renal replacement therapy (CRRT) was initiated, resolving encephalopathy.</p> Conclusions <p>NHHA should be considered in post-cardiac surgery patients presenting with altered mental status. Early recognition and CRRT intervention are crucial to prevent neurological deterioration.</p>

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Severe hyperammonemia following coronary artery bypass grafting

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年1月16日

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  • Suraj Rao,
  • John J. Nunnery,
  • Zachary W. Sollie,
  • Arman Kilic

摘要

Background

Hyperammonemia is a rare but serious cause of encephalopathy, commonly associated with hepatic dysfunction. However, non-hepatic hyperammonemia (NHHA) can arise due to impaired gastrointestinal transit, urease-producing organisms, and metabolic disorders. We present a case of NHHA following coronary artery bypass grafting (CABG).

Case presentation

A 56-year-old male with chronic alcohol use developed post-operative ileus and altered mental status on post-operative day 5 after an uncomplicated CABG. Despite normal liver function, ammonia levels peaked at 256 µmol/L. Given ileus, conventional therapy was deferred and continuous renal replacement therapy (CRRT) was initiated, resolving encephalopathy.

Conclusions

NHHA should be considered in post-cardiac surgery patients presenting with altered mental status. Early recognition and CRRT intervention are crucial to prevent neurological deterioration.