New Syndrome Affects Thousands of Patients

(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

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