TY  - JOUR
T1  - IAtrogenic hyperammonemia after anorexia
AU  - Welsh E, Kucera J, Perloff MD
Y1  - 2010/03/08
N1  - 10.1001/archinternmed.2009.549
JO  - Archives of Internal Medicine
SP  - 486
EP  - 488
VL  - 170
IS  - 5
N2  -  
    High-protein dietary supplements were started for 2 patients, who had a period of anorexia before hospital admission but no history of liver disease. Subsequent altered mental status with ataxia developed in both patients. After excluding other causes, hyperammonemia was noted, while liver function test results remained normal. Removal of the high-protein dietary supplements led to reversal of symptoms and normalization of the ammonia level. With the ubiquity of nutrition supplement use outside of liver failure, SHAKE (supplement-associated hyperammonemia after c[k]achetic episode) syndrome may be commonplace in modern hospitals.
SN  - 0003-9926
M3  - doi: 10.1001/archinternmed.2009.549
UR  - http://dx.doi.org/10.1001/archinternmed.2009.549
ER  -