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High volume CVVH in the control of ammonia encephalopathy in neonates

High volume CVVH in the control of ammonia encephalopathy in neonates. Germaine Pierre, Chris Hendriksz, Anupam Chakrapani Department of Inherited Metabolic Disease. Claire Westrope, Dave Burford, Gavin Morrrison Paediatric Intensive Care Unit.

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High volume CVVH in the control of ammonia encephalopathy in neonates

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  1. High volume CVVH in the control of ammonia encephalopathy in neonates Germaine Pierre, Chris Hendriksz, Anupam Chakrapani Department of Inherited Metabolic Disease Claire Westrope, Dave Burford, Gavin Morrrison Paediatric Intensive Care Unit Birmingham Children’s Hospital, Birmingham, England

  2. Background • Ammonia is normal metabolite of protein catabolism • Plasma levels >200µmol/l considered significant • Acute presentation in neonates often results in impaired level of consciousness progressing to coma, acidaemia and cardio-respiratory compromise

  3. Patients and Methods • Data collected • Demographic data • Presence of coma at presentation • Haemofiltration (CVVH) course • Efficacy data • Complications • Outcome data

  4. Results: Demographic data

  5. Results: Haemofiltration 1 Patient numbers in brackets

  6. Results: Haemofiltration 2

  7. Results: Efficacy median values (range)

  8. Results: Outcome 1 number (%)

  9. Results: Outcome 2

  10. Results: Outcome 3 Median values (range)

  11. Conclusions • High Volume CVVH is an effective and safe modality for the reduction of plasma ammonia levels in neonates with ammonia encephalopathy secondary to IMD • Factors which may influence outcome: • Initial Ammonia (?>1000) and/or Lactate levels • Underlying metabolic condition • Length of encephalopathy/coma prior to PICU admission • Inotrope requirement • %Fluid Overload • PRISM score

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