(Ivanhoe Newswire) -- The introduction of high protein dietary
supplements too quickly into the diet of patients eating poorly prior to their
hospital admission can cause symptoms of confused mental status, difficulty
walking and high levels of ammonia in the blood.
Researchers at Boston University School of Medicine (BUSM) coined the term SHAKE
(Supplement-associated Hyperammonemia After C(K)achetic Episode), for the
condition, which resulted in altered mental status and difficulty walking. The
new syndrome, potentially affecting thousands of hospital patients, can be
prevented by excluding high protein dietary supplements from a patient’s diet if
he or she has experienced poor eating for more than a week prior to entering the
hospital.
In the study, the neurology researchers described two cases in which both
patients were admitted to the hospital, for different reasons, after a period of
poor eating for more than a week. The first patient was put on high-protein
dietary supplements three times daily on day three of his stay. By day five,
this patient had slowed cognition and an unsteady gait requiring assistance. The
patient's ammonia level had doubled from baseline but his liver function tests
were normal. Typically, high ammonia levels indicate liver disease, but this
patient had no history of it. On day seven the high-protein supplements were
discontinued and within 24 hours his symptoms disappeared.
The second patient was also put on high-protein dietary supplements three times
daily on day three. By day six, her family noticed that she seemed confused and
would fall when walking. On day seven, her supplements were discontinued. She,
too, had high ammonia levels but normal liver function tests and had no history
of liver disease. Within 24 hours of stopping the supplements, her mental
status, ability to walk and ammonia levels had returned to normal. Both patients
resumed a regular diet with normal protein intake and returned to normal
activity after hospital discharge.
"When an altered mental status occurs in the inpatient setting, many possible
causes are considered," senior author Michael Perloff, M.D., Ph.D., of the
department of neurology at Boston University School of Medicine, was quoted as
saying. "However, in these two medically complex patients, the initiation of
high-protein dietary supplements was probably discounted, if even noticed. With
advances in nutritional education and supplements, this syndrome likely occurs
thousands of times per year in hospitals across the United States. We believe it
may account for more than 10,000 hospital days, countless morbidity and even
some mortality."
SOURCE: Archives of Internal Medicine, March 2010
