Two Cases of Hemodialysis-associated Chronic Portal-systemic Shunt Encephalopathy (CPSE) with Opposite Changes in the Blood Ammonia Concentrations during Hemodialysis: A Case Report and Literature Review
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- Oi Katsuyuki
- Department of Nephrology, Tokyo Medical and Dental University, Japan
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- Okado Tomokazu
- Department of Nephrology, Tokyo Medical and Dental University, Japan
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- Togo Hisako
- Department of Nephrology, Tokyo Kyosai Hospital, Japan
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- Iimori Soichiro
- Department of Nephrology, Tokyo Medical and Dental University, Japan
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- Yui Naofumi
- Department of Nephrology, Tokyo Medical and Dental University, Japan
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- Sohara Eisei
- Department of Nephrology, Tokyo Medical and Dental University, Japan
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- Kanda Eiichiro
- Department of Nephrology, Tokyo Kyosai Hospital, Japan
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- Rai Tatemitsu
- Department of Nephrology, Tokyo Medical and Dental University, Japan
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- Sasaki Sei
- Department of Nephrology, Tokyo Medical and Dental University, Japan
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- Uchida Shinichi
- Department of Nephrology, Tokyo Medical and Dental University, Japan
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抄録
The onset of hyperammonemia due to the flow of ammonia-rich portal vein blood through a portal-systemic shunt causes a type of encephalopathy known as chronic portal-systemic shunt encephalopathy (CPSE). We herein report two cases of CPSE that presented with opposite changes in the blood ammonia concentrations during hemodialysis. It is curious that the encephalopathy was ameliorated by hemodialysis in case 1, but not case 2. Therefore, it is necessary to recognize CPSE and assess the blood ammonia concentrations in dialysis patients who develop a disturbance of consciousness, even if the serum transaminase level is normal.<br>
収録刊行物
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- Internal Medicine
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Internal Medicine 54 (11), 1375-1380, 2015
一般社団法人 日本内科学会