These symptoms reflect ammonias dangerous effect on the brain.
A smaller amount is also produced in your muscles during intense exercise.
Your body normally eliminates ammonia through urine.
Chanin Wardkhian / Getty Images
Ammonia can damage brain cells and depleteneurotransmitters(brain chemicals).
Without prompt treatment, high ammonia levels can lead to death.
When to Seek Help
High ammonia is a medical emergency.
Sometimes, it may also result in a coma or death.
Without enough enzymes, the urea cycle isn’t effective at processing ammonia into urea.
Reye’s syndrome: This rare disorder of childhood and adolescence causes damage to the brain and liver.
Diagnosis
Your healthcare provider diagnoses high ammonia by running a blood test.
Test results are given in micrograms per deciliter (mcg/dL) or micromoles per liter (mcmol/L).
If your results fall outside the normal range, your provider runs additional tests to identify the cause.
Ranges for lab values may vary slightly by the testing method used by the lab.
Some labs may also use different measurements.
It is important to speak with your provider to understand the meaning of your specific results.
Because ammonia is toxic to the brain, there is no safe upper level of blood ammonia concentrations.
However, a blood concentration above 150 to 200 mcmol/L is considered to be high.
It can cause loss of brain function and even death.
Treatment
Treatment focuses on reducing ammonia and managing the underlying health condition.
In infants and children, high ammonia requires complex emergency care.
Their treatment may include intravenous fluids, ammonia-scavenging medications, and dialysis.
Lactulose is a first-line therapy often prescribed to decrease ammonia levels in patients with hepatic encephalopathy.
It works by pulling ammonia from the blood into the colon, where it is removed through the stool.
In more severe cases, protein may be temporarily restricted.
Specialty low-protein formulas are available for toddlers and infants who require a protein restriction.
If medical management is not successful, some people may require aliver transplant.
Summary
Ammonia is a toxic waste product made by the body during digestion and eliminated in urine.
If you have high ammonia levels, it has a toxic effect on the brain.
Symptoms include confusion, disorientation, excessive sleepiness, and difficulty speaking or thinking.
Treatment often involves medications such as lactulose and Xifaxan, which work to reduce ammonia levels.
In more severe cases, dialysis or a liver transplant may be necessary.
National Library of Medicine: MedlinePlus.Cirrhosis.
National Kidney Foundation.Chronic kidney disease.
MedlinePlus.Hereditary urea cycle abnormality.
National Organization for Rare Disorders.Reye syndrome.
2020 Nov;43(6):1165-1172. doi:10.1002/jimd.12292.
National Urea Cycle Disorders Foundation.Overview of urea cycle disorders.
Gupta S, Fenves AZ, Hootkins R.The role of RRT in hyperammonemic patients.Clin J Am Soc Nephrol.
2016;11(10):1872-1878. doi:10.2215/CJN.01320216
New England Consortium of Metabolic Programs.Neonate/infant/child with hyperammonemia.
MedlinePlus.Loss of brain function - liver disease.
