Nonhepatic hyperammonaemia is a rare disorder in the ICU. We describe a patient who developed hyperammonaemia after the administration of acetazolamide. Acetazolamide is a frequently used drug in the ICU for the correction of metabolic alkalosis. Acetazolamide-associated hyperammonemia may develop due to interference with the breakdown of ammonia through the urea cycle and through inhibition of the renal excretion of ammonia. Possible treatment options for hyperammonemia have been reviewed. Although the frequency of acetazolamide-induced hyperammonemia is unknown in ICU patients, it is a condition that must be considered when patients treated with acetazolamide show unexplained changes in consciousness.
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