24 August 2026
: Case report 
Refractory Hyperammonemic Encephalopathy as a Paraneoplastic Presentation of Fibrolamellar Hepatocellular Carcinoma: A Case Report
Management of emergency care, Rare disease
Ritwik Dey
ABDEF 1*, Harshitha Popuri ABDEF 1, Virali Gulla BDEF 1, Yagnapriya Chirrareddy EF 1, Satyapriya Paritala EF 1, Daniel Bustamante ABDE 2, Javier Corral ABDEF 3
DOI: 10.12659/AJCR.952819
Am J Case Rep 2026; 27:e952819
Table 1 Laboratory parameters at admission.
| Parameter | Result | Normal range |
|---|---|---|
| WBC (×10/μL) | 7.21 | 4.0–11.0 |
| HGB (g/dL) | 11.5 | 13.5–17.5 (male) / 12.0–15.5 (female) |
| PLT (×10/μL) | 520 | 150–450 |
| Prothrombin time (seconds) | 16.3 | 11.8–14.8 |
| INR | 1.3 | 0.9–1.1 |
| Serum sodium (mmol/L) | 136 | 135–145 |
| Serum potassium (mmol/L) | 4.1 | 3.5–5.1 |
| Bicarbonate (mmol/L) | 20 | 22–30 |
| Glucose serum (mg/dL) | 109 | 74–106 |
| BUN serum (mg/dL) | 6.9 | 9–20 |
| Creatinine (mg/dL) | 0.34 | 0.66–1.25 |
| Serum calcium (mg/dL) | 8.2 | 8.4–10.2 |
| Serum albumin (g/dL) | 2.9 | 3.5–5.0 |
| Serum protein (g/dL) | 5.0 | 6.3–8.2 |
| Total bilirubin (mg/dL) | 0.6 | 0.2–1.2 |
| AST (IU/L) | 145 | 10–50 |
| ALT (IU/L) | 184 | 10–50 |
| Alkaline phosphatase (IU/L) | 185 | 55–149 |
| Serum ammonia (μmol/L) | 271 | 0–35 |
| CRP (mg/dL) | 70.5 | 0–1.0 |
| Lactic acid (mmol/L) | 1.7 | 0.7–2.1 |
| Urine orotic acid (mmol/mol) | 9 | 0–2 |
| Hepatitis B surface antigen | Non-reactive | |
| Hepatitis B core antibody | Negative | |
| Hepatitis A, IgM | Negative | |
| Anti-hepatitis C antibody | Non-reactive | |
| Abbreviations: WBC, white blood cell count; HGB, hemoglobin; PLT, platelet count; BUN, blood urea nitrogen; CRP, C-reactive protein; AST, aspartate aminotransferase; ALT, alanine aminotransferase; ALP, alkaline phosphatase. | ||