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How do you evaluate and treat patients with cerebral edema secondary to hyperammonemia?
What modality do you prefer?
Answer from: at Academic Institution
The previous answer is a reasonable plan for the raised ICP. We need to remove ammonia - ammonia scavengers or dialysis are reasonable. If not liver cirrhosis, look for urea cycle issues even in adults, old GI surgical procedure that creates blind pouch with bacterial overgrowth, etc as other potent...
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Answer from: at Community Practice
I would evaluate patients with cerebral edema from hyperammonemia with a head CT only. There is usually not enough time to wait for brain MRI. An ICP monitor would be nice, but most of the time, there is no time to wait for this either. I would treat this initially with a 23% sodium chloride bolus a...
Answer from: at Community Practice
Agreed, removal of the ammonia via hemodialysis is the most commonly used method. If the hyperammonemia is fulminant, medical therapies with hypertonic solutions such as hypertonic saline or mannitol will not be sufficient to avoid brain herniation. If the patient is unstable, oftentimes a more cont...