Recurrent Hyperammonemia During Enteral Tube Feeding for Severe Protein Malnutrition After Bariatric Surgery

A 28-year-old female was admitted 2 years after gastric bypass limb distalization because of severe weight loss, fatigue, chronic diarrhea, massive edema, and a serum albumin of 10 g/L without proteinuria. A diagnosis of severe energy and protein malnutrition was made, and enteral tube feeding was started in combination with pancreatic enzyme supplementation every 3 h. Within 24 h after the start of tube feeding, she developed severe...