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.
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, SHAKE (supplement-associated hyperammonemia after c[k]achetic episode) syndrome may be common in modern hospitals.
Iatrogenic Hyperammonemia After Anorexia. Emily Welsh, BA; Jan Kucera, MD; Michael D. Perloff, MD, PhD. Arch Intern Med. 2010;170(5):486-488.
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