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Less frequent tear drop forms may arise in other systemic disease

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

Potential Side Effects and Risks Because L-Carnitine is naturally found in the body and diet, the injectable form is generally considered well-tolerated

ClinVar: public archive of relationships among sequence variation and human phenotype

Antioxidants: Vitamins C and E help delay muscle fatigue, fight muscle damage and help cardiovascular health while helping fight free radical damage