Acute Presentation and Management of the Encephalopathic Child With an Undiagnosed Inborn Error of Metabolism

Publication date: Available online 9 November 2018

Source: The Journal of Emergency Medicine

Author(s): Erin E. Bennett, Kevin Hummel, Andrew G. Smith, Nicola Longo

Abstract

Background

Inborn errors of metabolism (IEM) commonly present in infancy and, less commonly, later in life.

Case Report

This case describes an IEM, specifically, ornithine transcarbamylase deficiency, in a previously healthy 7-year-old boy who presented to an emergency department with vomiting for approximately 24 h prior to admission. The child became progressively encephalopathic while in the emergency department, but an ammonia level was not obtained until several hours after admission. Irreversible brain damage with cerebral edema was already present at time of diagnosis, leading to death.

Why Should an Emergency Physician Be Aware of This?

This case emphasizes that acute hyperammonemia can rapidly cause irreversible neurological damage and, in the case of a newly encephalopathic pediatric patient, ammonia levels should be evaluated early to facilitate proper diagnostic tests and treatment.

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