Abstract
Roux-en-Y gastric bypass (RYGB) is a commonly performed bariatric surgery for weight loss in the United States. Despite its widespread use, this invasive surgery is associated with several chronic complications. We present a case of a 37-year-old female who developed hyperammonemic encephalopathy (HE), a rare but potentially life-threatening complication following RYGB. This case adds to existing literature by emphasizing the importance of considering HE as a differential diagnosis in patients presenting with altered mental status post-RYGB and highlights the need for early recognition and effective management strategies to optimize patient outcomes.