The Drug-Induced Respiratory Disease Website

Gastric bypass (e.g. Roux-en-Y)

Hyperammoniemia (non-cirrhotic)

Nagarur A, Pierce TT, Fenves AZ, Witkowski ER, Gold NB

Case 30-2023: A 50-Year-Old Woman with Confusion.

The New England journal of medicine 2023 Sep 28;389;1221-1230 — 2023 Sep 28 — 1221-1230

Fenves AZ, Shchelochkov OA, Mehta A

Hyperammonemic syndrome after Roux-en-Y gastric bypass.

Obesity (Silver Spring, Md.) 2015 Apr;23;746-9 — 2015 Apr — 746-9

Diagnosing DIRD

Drug and radiation history

Drug singularity - Correct identification of the drug

Consistent timing of exposure v. onset of symptoms

Clinical, imaging, BAL, pathological pattern consistent with the specific drug

Careful exlusion of another cause

Remission of symptoms with removal of drug

Recurrence with rechallenge (rarely advisable)

Causality assessment

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