Chapter title |
Normal Neurological Development During Infancy Despite Massive Hyperammonemia in Early Treated NAGS Deficiency
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Chapter number | 13 |
Book title |
JIMD Reports, Volume 37
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Published in |
JIMD Reports, January 2017
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DOI | 10.1007/8904_2017_13 |
Pubmed ID | |
Book ISBNs |
978-3-66-256358-8, 978-3-66-256359-5
|
Authors |
Hallvard Reigstad, Berit Woldseth, Johannes Häberle, Reigstad, Hallvard, Woldseth, Berit, Häberle, Johannes |
Abstract |
A girl born at term was admitted to the neonatal intensive care unit because of mild respiratory distress after a complicated delivery. She recovered, but was readmitted at 58 h of life with mild respiratory distress and increased muscle tone. Neonatal abstinence syndrome because of maternal use of lithium, clomipramine, and quetiapine during pregnancy was suspected, but at 115 h of life she became unresponsive, and an immediate work-up for coma was initiated. An ammonia of 2,235 μmol/l was found, and treatment with sodium benzoate, sodium phenylacetate, arginine, glucose, and N-carbamylglutamate (NCG, Carbaglu(®)) was started. This treatment normalized plasma ammonia levels within 16 h.Biochemical results suggested a mitochondrial urea cycle defect, either of N-acetyl glutamate synthase (NAGS) or carbamoyl phosphate synthetase 1. DNA analysis later confirmed a diagnosis of NAGS deficiency. Under long-term treatment with NCG, the patient developed normally at last follow-up at 7 months of age.In conclusion, the standard neonatal situation of a neurologically compromised newborn turned out as a treatable rare inborn error of metabolism. In all neonates with somnolence and coma and hence the suspicion of a bacterial sepsis, plasma ammonia should be included in the work-up. NCG was immediately beneficial for the patient described and should be considered for the emergency treatment of neonatal hyperammonemia. Even a very high ammonia may allow for a normal neurological development in infancy (and possibly beyond). |
Mendeley readers
Geographical breakdown
Country | Count | As % |
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Unknown | 24 | 100% |
Demographic breakdown
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Other | 5 | 21% |
Student > Bachelor | 4 | 17% |
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Other | 2 | 8% |
Unknown | 7 | 29% |
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Other | 2 | 8% |
Unknown | 7 | 29% |