PMC4010020_01
The patient's serum ammonia charted against time after admission, with graphic representation of timing of interventions. CVVHD: continuous venovenous hemodialysis.
CRIM.CRITICAL.CARE2013-493216.001.jpg
PMC4010020_01_CRIM.CRITICAL.CARE2013-493216.001.jpg
fig1
 Over the next twelve hours, the patient's ammonia level worsened to 516 ug/dL (Figure 1).
CT of the head without contrast reveals evidence of mild cerebral edema.
CRIM.CRITICAL.CARE2013-493216.002.jpg
PMC4010020_01_CRIM.CRITICAL.CARE2013-493216.002.jpg
fig2
A repeat CT of his head demonstrated new cerebral edema (Figure 2).
Liver biopsy reveals centrilobular steatosis without fibrosis. (Hematoxylin and eosin, 40x.)
CRIM.CRITICAL.CARE2013-493216.003.jpg
PMC4010020_01_CRIM.CRITICAL.CARE2013-493216.003.jpg
fig3
Transcutaneous liver biopsy was obtained, revealing mild-to-moderate centrilobular steatosis without evidence of fibrosis (Figure 3).