Rarely a plasma cell tumor may produce excessive amounts of ammonia.


Patient selection: multiple myeloma


Clinical findings:

(1) elevated blood ammonia levels (hyperammonemia)

(2) encephalopathy with an impaired level of consciousness

(3) exclusion of liver disease or other conditions associated with hyperammonemia


Additional findings:

(1) often produce IgA or IgD

(2) often aggressive or chemotherapy-resistant

(3) elevated ammonia in the supernatant of cultured myeloma cells


Failure to control the myeloma and the ammonia production can be fatal.


Successful treatment of the myeloma results in correction of the hyperammonemia and clinical improvement.


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