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CONTENTS Intro: Hyperammonemia is a serial killer Clinical presentation & diagnosis Causes Investigation & monitoring Management [1] Neurocritical care of hyperammonemia [2] Reduced enteral ammonia absorption [3] Basic nutritional manipulations [4] Discontinue potentially offensive medications [5] Consider treatment for infectious etiologies [6] Consider zinc supplementation [7] Consider carnitine supplementation [8] Consider additional vitamins [9] Consider L-arginine administration [10] Support renal clearance & consider CRRT [11] Sodium phenylacetate plus sodium benzoate (Ammonul) hyperammonemia is a serial killer hyperammonemia is a serial killer Nonhepatic hyperammonemia behaves like a serial killer

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It has also caused doctors to reiterate warnings about excessive consumption of red meat and especially kangaroo meat, which has long been thought to be one of the healthiest choices because of its low fat content

Quality Check was performed according to the established pipeline used by previous epidemiological studies and international metabolomics consortia [31, 43,44,45]

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