High ammonium: values ​​and related diseases

High ammonium: values ​​and related diseases

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If you have recently performed an exam to verify theammonia, we will help you interpret the results of the analyzes.

With the term ammoniathe levels ofammonium in the bloodor in the urine. Before taking the sample to check ammonium levels (ammonia), you must fast for at least 8 hours. During this time, a moderate amount of water is allowed.

How does ammonium end up in our blood?Ammonium (chemical formula NH3) is the final product ofprotein metabolism. It is formed by the action of the bacteria of our intestinal flora and by the hydrolysis of glutamine (an amino acid) in the kidneys. If the analyzes revealed ahigh ammonium level it is of fundamental importance to consult your doctor. When ammonium values ​​are high we speak ofhyperammonaemia.

L'ammoniumfree is very toxic to the central nervous system. In an efficient organism, it is the liver that processes theammoniumand convert it toureathen expelled with theurine.

High ammonium: what diseases?

As stated, before reaching hasty conclusions it is important to consult a doctor who can analyze the entire clinical picture. L'high ammonium, that is, the increase in ammonium in the blood is related to different situations. It is no coincidence that theammoniais a test generally prescribed in case of suspicion of:

  • Fulminant liver failure
  • Cirrhosis of the liver
  • Reye's syndrome
  • Gastrointestinal bleeding
  • Gastrointestinal infections with distention and stasis
  • Diseases that interfere with the metabolic cycle of urea
  • Pathologies that interfere with cycles related to protein metabolism and the urea cycle

THEnormal values, that is, the reference standards seeammonium levelsin the blood between 11 - 48 µMol / L in women and 15 - 55 µMol / L in men. THEreference values they can change according to age and also according to the standardization of the clinical center that performed the sample.

What to do and who to contact?

You can not help but refer to the opinion of the attending physician. Generally, the doctor intervenes on the cause that triggered the increase in ammonium values.

It is also difficult to answer the question "which doctor to contact? "as it depends on the cause that triggered thehyperammonaemia. Typically, the nephrologist is the specialist indicated in case of diseases that interfere with theurea cyclein the kidney.

In other cases it may be appropriate to a gastroenterologist or a hepatologist gastroenterologist. In rare cases, it may be appropriate to consult an immunologist or rheumatologist in case of an autoimmune disease that has attacked the liver.

Examsblood chemistrythey can give you a more correct indication. Routine exams may already highlight one possibleliver diseaseeven in the absence of hepatomegaly on examination of the abdomen.

Other blood tests that may be prescribed by the specialist are: the plasma amino acidogram, urinary amino acid dosage and plasma and urinary homocitrullinemia. With the appropriate tests, the doctor will be able to make a diagnosis or request more precise tests. Unfortunately thehigh ammoniumit can also be a condition of some rare genetic diseases.


The intervention of the doctor is of fundamental importance because thetreatment of hyperammonaemiamust be performedimmediately, even before getting a diagnosis.

The choice of treatment must be performed on the basis ofammonium levels detectedbut also based on other data such as the patient's medical history and age. Typically, forlower ammonium levelsand to prevent intoxication the specialist prescribesEPS lactulose.

Always generalizing, in case ofhigh ammoniumit is important to avoid legumes and red meat, prefer vegetables, carbohydrates and a low-protein diet.

In more serious cases (acute or chronic liver cirrhosis), the doctor may recommend an enema to empty the intestine so as to avoid the absorption and circulation of ammonium in the blood.

Low ammonium

An increase in ammonium values ​​in the blood it is found in acute and chronic liver disease, diabetic and uremic coma, heart failure ... and in the diseases listed above. Conversely, a decrease in the vnormal alues of ammonium in the blood (hypoammonemia) is found in the following conditions:

  • Simmonds disease
  • Low protein diet
  • Hyperornithinemia

Even the use of some drugs can cause a decrease in normal ammonium levels in the blood (lactulose, neomycin, kanamycin, L-dopa ...).

Blood test tube

Laboratory curiosity: thetest tubeused for ammonia is generally onetest tubeused in the field ofurgency analysis.

It has a transparent lilac cap (transparent EDTA 4 cc tube), absolutely not to be confused with the 6 cc pink cap or 4 or 2 cc transparent lilac cap tube, the latter used for the most common tests. such as blood count, ESR, erythroblasts…!

Video: Why Elevated Ammonia in blood is toxic?: Biochemical basis for neurotoxicity (May 2022).