LAUSR

One third of children and adolescents in the USA are classified as either overweight or obese [1]. Moreover, 4.4 million children and adolescents have severe obesity [2]. There has been an increased volume of adolescent bariatric surgeries performed nationwide with reported cases doubled from 800 operations in 2003 to 1600 operations in 2009 [1, 3]. In adolescents, the most common procedure formorbid obesity is the Roux-en-Y gastric bypass (RYGB), accounting for 67.9% of cases [4]. The most common acute complications after RYGB include anastomotic leak, hemorrhage, early small-bowel obstruction, or incorrect limb reconstruction [5]. However, metabolic derangements such as metabolic acidosis or alkalosis, electrolyte abnormalities that may cause arrhythmias, and/or myopathies can occur. Additionally, nutritional abnormalities including fat-soluble vitamin, iron, folic acid, thiamine, vitamin B12, calcium, and vitamin D deficiency can also occur [6–9]. One rare but potent ia l ly fatal derangement is hyperammonemic encephalopathy (HAE). There have been less than 25 reported cases of HAE following bariatric surgery with a mortality rate of 50% [10–15]. We describe the first pediatric patient with HAE after successful RYGB.