Hyperammonemia is a common condition in cirrhotic patients. In the context of a non-cirrhotic cause, this is related to the increase in its production of ammonium or alteration in its elimination. The clinical presentation is nonspecific, from the alteration of the behavior to the coma, being one of the causes of non-renal dialysis due to certain values or refractoriness to medical management. The case of a 35-year-old woman is presented, who is admitted to the emergency department with altered state of consciousness, elevated ammonium levels and hypervascular mass in the liver. Biopsy of the liver lesion reports fibrolamellar liver carcinoma. The presence of a portosystemic shunt that causes hyperammonemia is attributed to this pathology. Dialysis is indicated by persistence of ammonium elevations with little response to medical treatment. In its evolution, it required a restart of renal replacement due to a reappearance of the encephalopathic state when it was suspended. This therapy is maintained until liver transplantation performed as a carcinoma treatment, with subsequent stabilization of ammonium levels and dialysis suspension.
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