Researchers from Boston University School of Medicine (BUSM) have identified a new syndrome affecting potentially thousands of hospital inpatients. Coined SHAKE (Supplement-associated Hyperammonemia After C(K)achetic Episode), the condition, which results in altered mental status and difficulty walking, can be prevented by excluding high protein dietary supplements in a patients' diet if they have experienced poor eating for more than a week prior to their admittance. The condition is described in the March issue of the Archives of Internal Medicine.

Altered mental status describes a disorder of impaired cognition, diminished attention, reduced awareness or an altered consciousness level. Ten to 50 percent of hospitalized patients will experience acute altered mental status which accounts for a significant portion of neurological inpatient consultation.

In the study, the neurology researchers describe two cases in which both patients were admitted to the hospital (medical sick for different reasons) after a period of poor eating for more than a week. The first patient was put on high-protein dietary supplements three times daily on day three of his stay. By day five, this patient had slowed cognition and an unsteady gait requiring assistance. The patient's ammonia level had doubled from baseline but his liver function tests were normal. Typically, patients exhibiting high ammonia levels present with liver disease but this patient had no history of it. On day seven the high-protein supplements were discontinued and within 24 hours his symptoms disappeared.