Editing Intestinal Segments and Urinary Diversion (section)

==== <span style="color:#ff0000">Altered </span><span style="color:#0000ff">S</span><span style="color:#ff0000">ensorium ====
* '''May occur as a consequence of magnesium deficiency, drug intoxication, or abnormalities in ammonia metabolism'''
* '''Ammoniagenic coma in patients with urinary intestinal diversion is most commonly associated with decreased liver function.'''
** '''Ammonium excreted by the kidneys is reabsorbed by the intestinal segment,''' and then returned to the liver via the portal circulation. The liver metabolizes ammonium to urea via the ornithine cycle.
** '''The liver usually adapts to the excess ammonia and rapidly metabolizes it; hepatic dysfunctionmay therefore result in ammoniagenic coma.'''
*** Ammoniagenic coma can occur in patients with normal hepatic function.
**** Systemic bacteremia, with endotoxin production, inhibits hepatic function and may precipitate this clinical entity. Urinary tract infections with urea-splitting organisms may also overload the ability of the liver to clear the ammonia.
**** If this syndrome occurs in a patient suspected of having near normal hepatic function, systemic bacteremia or urinary obstruction should be suspected.
** '''Prompt urinary drainage''' with treatment of the offending urinary pathogens along with systemic antibiotics '''and the administration of oral neomycin or lactulose to reduce absorption of ammonia in the gastrointestinal tract are the key components to patient management.'''