Hyperammonemia Following Cytoreductive Chemotherapy

Features of chemotherapy-induced hyperammonemia:

(1) normal mental status and plasma ammonia levels prior to chemotherapy

(2) high dose chemotherapy administered

(3) onset of altered mental status with lethargy and confusion, often with some degree of cerebral edema on imaging studies

(4) elevated plasma ammonia level

(5) exclusion of other causes of hyperammonemia (including liver disease and multiple myeloma)

If the person survives the episode then the ammonia and symptoms should return to normal.