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Hyperammonemia as an Adverse Effect in Parenteral Nutrition

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Diet and Nutrition in Critical Care

Abstract

Nutritional support is an essential element in the aggregate care of the chronic disease and/or critical patient. Many a times, the patients’ nutritional status has been a major predictor for the outcome and prognosis of diseases. Since 1967, assisted nutrition, mainly as total parenteral nutrition (TPN) to provide the necessary calories from carbohydrates, proteins, and lipids and also to furnish selected minerals, electrolytes, and essential vitamins, has been administered intravenously through a central venous catheter to the extremely sick patients who cannot obtain their required nutrition through enteral route. The advantage of parenteral nutrition is that it can be customized for individual requirement, though a standard solution could still be used. Though studies have clearly proven the superiority of the assisted nutrition in the betterment of the outcome of these patients, TPN is certainly associated with adverse effects and complications. Of all the complications associated with TPN, we will focus on hyperammonemia which could be a complication related to the type and quantity of the amino acids present in the TPN (Ghadimi et al. Pediatrics 48:955–965; 1971).

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Abbreviations

ALT:

Alanine aminotransferase

ASPEN:

American Society for Parenteral and Enteral Nutrition

AST:

Aspartate aminotransferase

BCAT:

Branched-chain aminotransferase

EAA:

Essential amino acids

EDTA:

Ethylenediaminetetraacetic acid

fMRI:

Functional magnetic resonance imaging

GI:

Gastrointestinal

HE:

Hepatic encephalopathy

IEM:

Inborn errors of metabolism

LBW:

Low birth weight

OTC:

Ornithine transcarbamoylase (ornithine carbamoyltransferase)

PCT:

Proximal convoluted tubule

PN:

Parenteral nutrition

RRT:

Renal replacement therapy

TPN:

Total parenteral nutrition

UCD:

Urea cycle disorders

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Authors and Affiliations

  1. Hospital Medicine, The Toledo Hospital, 43606, Toledo, OH, USA

    Joe V. M. Devasahayam

  2. Department of Medicine, University of Arizona, 85724, Tucson, AZ, USA

    Santhosh G. John & Seth Assar

  3. Division of Nephrology, Wayne State University, 48201, Detroit, MI, USA

    Zeenat Y. Bhat

  4. Department of Medicine, St Marys Health Center, 63117, St Louis, MO, USA

    Aparna N. Kurup

  5. Academic Hospitalist, Ball Memorial Hospital, 47303, Muncie, IN, USA

    Suresh Hosuru

  6. Department of Neurology, University of Toledo, 43608, Toledo, OH, USA

    Valentina Joseph

  7. Nephrology, Indiana University, Ball Memorial Hospital, 800 N Tillotson Avenue, Muncie, IN, USA

    Unnikrishnan Pillai

Authors
  1. Joe V. M. Devasahayam
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  2. Santhosh G. John
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  3. Seth Assar
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  4. Zeenat Y. Bhat
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  5. Aparna N. Kurup
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  6. Suresh Hosuru
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  7. Valentina Joseph
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  8. Unnikrishnan Pillai
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Correspondence to Unnikrishnan Pillai .

Editor information

Editors and Affiliations

  1. Department of Nutrition, King's College London, London, United Kingdom

    Rajkumar Rajendram

  2. School of Medicine, King's College London, London, United Kingdom

    Victor R. Preedy

  3. Department of Biomedical Sciences, University of Westminster, London, United Kingdom

    Vinood B. Patel

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Devasahayam, J.V.M. et al. (2014). Hyperammonemia as an Adverse Effect in Parenteral Nutrition. In: Rajendram, R., Preedy, V., Patel, V. (eds) Diet and Nutrition in Critical Care. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-8503-2_159-1

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  • DOI: https://doi.org/10.1007/978-1-4614-8503-2_159-1

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  • Online ISBN: 978-1-4614-8503-2

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