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We present two cases of hyperammonemic encephalopathy secondary to urea- splitting urinary tract infection with urinary diversion.One patient had a ureterosigmoidostomy,the other an ileal loop diversion.Neither patient had significant underlying liver disease,but both had considerable muscle atrophy that may have predisposed them to develop hyperammonemia.Medical therapy did not provide long-term control of symptoms.In both cases, hyperammonemic encephalopathy resolved after revision of their urinary diversions.The probable mechanism of the metabolic derangements produced by urea-splitting urinary tract infections is reviewed.We suggest that patients with urinary diversion who develop hyperammonemic encephalopathy secondary to a urea-splitting urinary tract infection be treated with surgical revision of the urinary system to improve drainage and decrease bowel contact time. |
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