Ornithine Transcarbamylase Deficiency: If at First You Do Not Diagnose, Try and Try Again

Santos, Christan D. and Ratzlaff, Robert A. and Meder, Jennifer C. and Atwal, Paldeep S. and Joyce, Nicole E. (2017) Ornithine Transcarbamylase Deficiency: If at First You Do Not Diagnose, Try and Try Again. Case Reports in Critical Care, 2017. pp. 1-4. ISSN 2090-6420

[thumbnail of 8724810.pdf] Text
8724810.pdf - Published Version

Download (1MB)

Abstract

Ornithine transcarbamylase (OTC) deficiency is well known for its diagnosis in the neonatal period. Presentation often occurs after protein feeding and manifests as poor oral intake, vomiting, lethargy progressing to seizure, respiratory difficulty, and eventually coma. Presentation at adulthood is rare (and likely underdiagnosed); however, OTC deficiency can be life-threatening and requires prompt investigation and treatment. Reports and guidelines are scarce due to its rarity. Here, we present a 59-year-old woman with a past history of irritable bowel syndrome who underwent a reparative operation for rectal prolapse and enterocele. Her postoperative course was complicated by a bowel perforation (which was repaired), prolonged mechanical ventilation, tracheostomy, critical illness myopathy, protein-caloric malnutrition, and altered mental status. After standard therapy for delirium failed, further investigation showed hyperammonemia and increased urine orotic acid, ultimately leading to the diagnosis of OTC deficiency. This case highlights the importance of considering OTC deficiency in hospitalized adults, especially during the diagnostic evaluation for altered mental status.

Item Type: Article
Subjects: Oalibrary Press > Medical Science
Depositing User: Managing Editor
Date Deposited: 29 Dec 2022 06:46
Last Modified: 04 May 2024 04:24
URI: http://asian.go4publish.com/id/eprint/824

Actions (login required)

View Item
View Item