Sudden development of adult-onset type II citrullinemia after total gastrectomy: a case report

Surgical Case Reports

Table 1 Summary of the serum ammonia level and state of consciousness

	NH3(μg/dL)	State of consciousness	Diet before symptom onset	BCAAs
Days after operation
13	478	Coma	Ordinary	Nothing
15	52	Alert	NPO	i.v.
Days after adjuvant chemotherapy
14	46	Aberrant behaviors	Ordinary	Nothing
28	858	Coma	Ordinary	Nothing
29	93	Coma	NPO	i.v.
30	51	Alert	NPO	i.v.
Days after starting nutritional therapy
1	NM	Alert	NPO	Nothing
7	237	Coma	Low-carbohydrate, high-protein/fat	i.v.
8	156	Aberrant behaviors	NPO	i.v.
11	442	Coma	Low-carbohydrate, high-protein/fat	i.v.
18	13	Alert	NPO	Nothing
27	47	Alert	Low-carbohydrate, high-protein/fat	Nothing
28	478	Coma	Low-carbohydrate, high-protein/fat	i.v.
29	52	Drowsiness	NPO	i.v.
30	12	Alert	Unbalanced	p.o.
36	148	Aberrant behaviors	Unbalanced	p.o.
37	NM	Alert	Unbalanced	p.o.
39	125	Drowsiness	Unbalanced	p.o.
42	NM	Alert	Unbalanced	p.o.
44	147	Drowsiness	Unbalanced	p.o.
45	NM	Alert	Unbalanced	p.o.

NM Not measurement, NPO Nothing per os, i.v. Intravenous injection, p.o. Per os
Unbalanced diet means taking only nut, cheese, fish, and small amout of carbohydrate