Escherichia Coli Urinary Tract Infection Related Hyperammonemia: Clinical Spectrum and Outcome

INTRODUCTION: Elevated serum ammonia levels are common in patients having liver disease. Hyperammonemia without liver disease is rare. The urinary tract infection (UTI) due to Escherichia Coli (E. Coli) and its associated hyperammonemia is also rare. These patients usually present with signs and symptoms of urinary tract and encephalopathy (due to elevated serum ammonia). Suspicion of hyperammonemia in patients with UTI with altered sensorium along with appropriate treatment can reduce morbidity and mortality. OBJECTIVES: To study clinical spectrum and outcome in patients having hyperammonemia secondary to E. coli UTI. MATERIALS AND METHODS: This retrospective study was conducted in a multispecialty Tertiary care referral hospital. Twenty-one patients with E. coli-associated UTIs and elevated serum ammonia levels were included in the study, which lasted six months from October 2023 to March 2024. RESULTS: The 21 patients in our study (10 males and 11 females) had E. Coli associated urinary tract infection along with elevated serum ammonia levels. The clinical features include fever, burning micturition, loose stools, generalized body aches, reduced urine output, reduced food intake, abdominal pain, and altered sensorium. Diabetes mellitus was the most common comorbid condition in these patients. Ten patients had pyelonephritis and remaining eleven with cystitis. The average serum ammonia level was 77.63 mmol/L (20-40 mmol/L is normal). The average serum creatinine was 2.52 mg/dL and the average period of intensive care unit (ICU) stay was 6.33 days. Out of 21 patients, 19 patients survived and 2 patients died due to the preexisting multiple comorbid conditions and multi-organ dysfunction syndrome (MODS). DISCUSSIONS/CONCLUSIONS: E. Coli infection of the urinary tract can cause hyperammonemia. The encephalopathy in these patients is due to elevated ammonia levels in the blood. This study shows that measuring serum ammonia levels is all that is needed in E. Coli urinary tract infection with altered sensorium. We can avoid unnecessary investigations such as electroencephalography (EEG), magnetic resonance imaging (MRI) brain, and lumbar puncture (diagnostic) for altered sensorium. Overall, early diagnosis and effective treatment can reduce morbidity and mortality.