Refractory Hyperammonemic Encephalopathy as a Paraneoplastic Presentation of Fibrolamellar Hepatocellular Carcinoma: A Case Report

24 August 2026 : Case report USA

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

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Table 2 Plasma amino acid levels.

Plasma amino acid	Result (μmol/L)	Reference range (μmol/L)	Flag
Aspartic acid	3	1–4	Normal
Glutamic acid	55	10–97	Normal
Hydroxyproline	< 1	4–27	Low
Serine	71	65–138	Normal
Asparagine	18	31–64	Low
Alpha-aminoadipic acid	< 1	≤ 2	Normal
Glycine	120	122–322	Low
Glutamine	299	428–747	Low
Sarcosine	2	≤ 4	Normal
Beta-Alanine	3	≤ 5	Normal
Taurine	26	31–102	Low
Histidine	36	60–109	Low
Citrulline	2	16–51	Low
Arginine	17	43–107	Low
Threonine	35	67–198	Low
Alanine	174	200–483	Low
1-Methylhistidine	25	≤ 47	Normal
Gama-Aminobutyric acid	< 1	≤ 3	Normal
3-Methylhistidine	2	2–9	Normal
Beta-Aminoisobutyric acid	< 2	≤ 3	Normal
Proline	97	104–383	Low
Ethanolamine	5	5–13	Normal
Alpha-Aminobutyric acid	12	7–32	Normal
Tyrosine	47	38–96	Normal
Valine	106	132–313	Low
Methionine	15	16–34	Low
Cystathionine	< 1	< 1	Normal
Isoleucine	50	34–98	Normal
Leucine	62	73–182	Low
Phenylalanine	29	40–74	Low
Tryptophan	22	40–91	Low
Ornithine	< 1	27–83	Low
Lysine	106	119–233	Low

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