A 60-year-old man on ICU has acute liver failure. His NH3 (ammonia) is 210 µmol/L and rising. He has grade 3 hepatic encephalopathy. ICP monitoring sh...

Question

A 60-year-old man on ICU has acute liver failure. His NH3 (ammonia) is 210 µmol/L and rising. He has grade 3 hepatic encephalopathy. ICP monitoring shows ICP 22 mmHg. The team considers measures to lower ammonia. Which intervention may acutely lower serum ammonia in the ICU setting?

Accepted Answer

Continuous renal replacement therapy (CRRT) - CRRT effectively clears ammonia from the blood and may be considered when ammonia levels are critically elevated (>150-200 µmol/L) in acute liver failure with cerebral oedema

Answer

Oral lactulose only

Answer

IV dexamethasone

Answer

Increasing dietary protein

Answer

Blood transfusion

uk-fficm MCQ (SBA): Hyperammonaemia - CRRT

A 60-year-old man on ICU has acute liver failure. His NH3 (ammonia) is 210 µmol/L and rising. He has grade 3 hepatic encephalopathy. ICP monitoring shows ICP 22 mmHg. The team considers measures to lower ammonia. Which intervention may acutely lower serum ammonia in the ICU setting?