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Authors

  • Mathilde Piljan Sorbonne Université, AP-HP.Sorbonne Université, Hôpital de la Pitié-Salpêtrière, Médecine Intensive Réanimation à orientation neurologique, Paris, France
  • Antoine Villa Sorbonne Université, AP-HP.Sorbonne Université, Hôpital de la Pitié-Salpêtrière, Médecine Intensive Réanimation à orientation neurologique, Paris, France
  • Nicolas Weiss Sorbonne Université, AP-HP.Sorbonne Université, Hôpital de la Pitié-Salpêtrière, Médecine Intensive Réanimation à orientation neurologique, Paris, France - Brain Liver Pitié-Salpêtrière (BLIPS) Study Group, INSERM UMR_S 938, Centre de recherche Saint-Antoine, Maladies métaboliques, biliaires et fibro-inflammatoire du foie, Institute of Cardiometabolism and Nutrition (ICAN), Paris, France -Groupe de Recherche Clinique en REanimation et Soins intensifs du Patient en Insuffisance Respiratoire aiguE (GRC-RESPIRE) Sorbonne Université
  • Rana Alkouri AP-HP.Sorbonne Université, Hôpital de la Pitié-Salpêtrière, Service de Biochimie Métabolique, DMU BioGeM, Paris, France
  • Kevin Bihan Pharmacology Department, AP-HP, GHU Sorbonne University, Regional Pharmacovigilance Centre Pitié-Saint Antoine, Paris, France
  • Mehdi Sakka AP-HP.Sorbonne Université, Hôpital de la Pitié-Salpêtrière, Service de Biochimie Métabolique, DMU BioGeM, Paris, France
  • Dominique Thabut Sorbonne Université, AP-HP.Sorbonne Université, Hôpital de la Pitié-Salpêtrière, Service d’hépato-gastroentérologie, Paris, France Brain Liver Pitié-Salpêtrière (BLIPS) Study Group, INSERM UMR_S 938, Centre de recherche Saint-Antoine, Maladies métaboliques, biliaires et fibro-inflammatoire du foie, Institute of Cardiometabolism and Nutrition (ICAN), Paris, France
  • Charlotte Bouzbib Sorbonne Université, AP-HP.Sorbonne Université, Hôpital de la Pitié-Salpêtrière, Service d’hépato-gastroentérologie, Paris, France - Brain Liver Pitié-Salpêtrière (BLIPS) Study Group, INSERM UMR_S 938, Centre de recherche Saint-Antoine, Maladies métaboliques, biliaires et fibro-inflammatoire du foie, Institute of Cardiometabolism and Nutrition (ICAN), Paris, France

DOI:

https://doi.org/10.37051/mir-34-002213

Keywords:

ammonia, hyperammonia, cirrhosis, acute liver injury, cardiac arrest, encephalopathy

Abstract

If hyperammonemia, defined by an increase in plasma ammonium concentration, is a situation that any intensivist may encounter, its etiological and therapeutic management remains relatively unfamiliar to clinicians. However, the consequences of hyperammonemia can be severe, particularly when levels exceed 150 µmol/L, where neurological complications (such as cerebral edema and brain herniation) become life-threatening. 

From an etiological perspective, it is essential to distinguish hepatic causes, which account for 80-90% of cases, from non-hepatic causes, which pose an additional diagnostic challenge, including portosystemic shunts, drug-induced origins, inherited metabolic disorders, etc. 

Various symptomatic treatments—both pharmacological and non-pharmacological—can be implemented alongside the treatment of the underlying cause, if identified, to rapidly reduce ammonia levels and, consequently, morbidity and mortality. 

This review aims to help intensivists better understand the underlying pathophysiological mechanisms and clinical situations that should prompt consideration of hyperammonemia, identify the main etiologies in this context, and propose a therapeutic approach based on current scientific knowledge to improve patient outcomes.

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Published

2025-06-11

How to Cite

Piljan, M., Villa , A., Weiss, N., Alkouri, R., Bihan, K., Sakka, M., Thabut, D., & Bouzbib, C. (2025). Français . Médecine Intensive Réanimation, 34(Hors-série). https://doi.org/10.37051/mir-34-002213

Issue

Vol. 34 No. Hors-série (2025): Spécial Foie

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