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Abstract
There have been reports that hyperammonemia and amino acid disturbance can cause loss of consciousness in patients with multiple myelomas and normal liver function. We experienced a case of a 71-years-old female patient with amyloidosis, who had shown disturbance of consciousness. At that time, the serum ammonia level was elevated; serum amino acids disturbance was also noted. In particular, the decrease in branched-chain amino acids and increase in aromatic amino acids results in a low Fisher ratio. The Fisher ratio, the ratio of branched-chain to aromatic amino acids, has been suggested as an important indicator of consciousness disturbance. We report, for the first time in Korea, a case of amyloidosis, with mental disturbance due to serum amino acid disturbance.
REFERENCES
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Fig. 1.
Some arteriolar walls are thickened by amorphous material deposits. There are multifocal chronic inflammatory cell infiltration and fibrosis associated tubular atrophy. The deposits are Congo-red positive (A: H&E ×400, B: Congo-red, ×400).
Table 1.
Characteristics of serum amino acid disturbance in this case (nmol/mL)
| Compounds | Results | Results | Normal range |
|---|---|---|---|
| Hospital day | D+9 | D+16 | |
| Glycine | 91.2 | 271.1 | 151.0～490.0 |
| Tylosine | 35.9 | 9.8 | 34.0～112.0 |
| Valine | 109.2 | 139.7 | 119.0～336.0 |
| Leucine | 53.5 | 76.4 | 72.0～201.0 |
| Isoleucine | 35.0 | 63.6 | 30.0～108.0 |
| Phenyalanine | 330.1 | 22.3 | 35.0～85.0 |
| Fisher ratio∗ | 0.53 | 8.71 | 2.6～4.3 |
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