Abstract
This chapter describes the clinical approach and dialytic management of neonatal hyperammonemia. Newborns with hyperammonemia typically present as a metabolic emergency between the ages of 24 and 48 h. Early management including glucose infusion, protein restriction, and pharmacologic intervention with nitrogen scavengers is important to limit neurological damage. Dialysis is required to urgently remove ammonia if pharmacologic intervention is insufficient to remove the ammonia load, with high-dose continuous venovenous hemodiafiltration (CVVHDF) the modality of choice in most cases. Intermittent hemodialysis may be required initially in the presence of severe hyperammonemia to rapidly reduce ammonia levels, followed by CVVHDF to prevent ammonia rebound. The severity of the neurological outcome appears to be related to the duration of severe hyperammonemia and not to peak ammonia levels.
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Yap, HK. (2017). Neonatal Hyperammonemia. In: Warady, B., Schaefer, F., Alexander, S. (eds) Pediatric Dialysis Case Studies. Springer, Cham. https://doi.org/10.1007/978-3-319-55147-0_41
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DOI: https://doi.org/10.1007/978-3-319-55147-0_41
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