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Hyperosmolarity in children with hyperammonemia: a risk of brain herniation at the start of renal replacement therapy

Authors :
Yousra Maghmoul
Arnaud Wiedemann
Lucile Barcat
Fabienne Parente
Pierre Allard
Fernando Alvarez
Philippe Jouvet
Source :
Frontiers in Pediatrics, Vol 12 (2024)
Publication Year :
2024
Publisher :
Frontiers Media S.A., 2024.

Abstract

PurposeRenal replacement therapy (RRT) is used in hyperammonemia to reduce the concentration of ammonia in the blood. In the case of plasma hyperosmolarity, RRT can also rapidly decrease plasma osmolarity, which may increase cerebral edema in these patients and favor the occurrence of brain herniation.MethodsWe conducted a retrospective clinical study in a tertiary care university-affiliated hospital. All patients admitted in a Pediatric Intensive Care Unit (PICU), less than 18 years old with ammonemia >150 µmol/L and who underwent RRT between January 2015 and June 2023 were included. We collected data on plasma osmolarity levels, osmolar gap and blood ammonia levels before and during RRT.ResultsEleven patients were included (10 with acute liver failure and 1 with a urea cycle disorders). Their mean age was 36.2 months. Before RRT, the median highest measured osmolarity was 320 (305–324) mOsm/L, whereas the median calculated osmolarity was 303 (293–314) mOsm/L, corresponding to an osmolar gap of 14 mOsm/L. Ammonia blood level over 400 µmol/L are significantly associated with higher plasma osmolarity (P-Value

Details

Language :
English
ISSN :
22962360
Volume :
12
Database :
Directory of Open Access Journals
Journal :
Frontiers in Pediatrics
Publication Type :
Academic Journal
Accession number :
edsdoj.9be256a34ac4927bfe0db4ef3037b2c
Document Type :
article
Full Text :
https://doi.org/10.3389/fped.2024.1431008