Abstract
A 63-year-old woman developed severe hyperammonemia and psychomotor slowing following percutaneous endoscopic gastrostomy (PEG) and continuous enteral nutrition (EEN) for anxiety-related feeding difficulties. Despite normal neuroimaging, her plasma ammonia levels peaked at 117.6 μmol/L. Immediate management via PEG removal and transition to a semi-liquid oral diet successfully normalized ammonia levels and restored cognitive function. This case highlights that PEG-associated EEN, potentially combined with specific formula deficiencies or metabolic vulnerabilities, can precipitate hyperammonemia. Surgeons and gastroenterologists should recognize unexplained psychomotor slowing as a critical diagnostic trigger for hyperammonemia in patients on long-term enteral feeding to ensure prompt intervention.
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