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(28152637) IV L-arginine might be a reasonable consideration in the following situations: i) Moderate to severe hyperammonemia, without immediate access to hemodialysis ii) Persistent hyperammonemia, despite hemodialysis iii) Hyperammonemia which poses an immediate threat to life (e.g., moderate to severe hyperammonemia with evidence of cerebral edema) A reasonable dose may be: (22642880) Loading bolus of 250 mg/kg (1.2 mM/kg) over 2 hours

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Funding: SUN is supported by the National Institute of Diabetes and Digestive and Kidney Diseases (1U01DK123818)