Elevated Blood Ammonia Levels: Causes, Symptoms, and Testing

Blood ammonia

I have alcoholic hepatitis, coronary artery disease, a minor stroke, and gallstones.
Recently, I went to the emergency room due to abdominal bloating, chest pain, and difficulty breathing.
Blood tests showed my serum ammonia level was 130.
The doctor informed me that this level is elevated.
What diseases are associated with elevated ammonia levels, and what symptoms might they cause? My father has liver cancer, and my uncle has blood cancer.
Is elevated ammonia a rare disease? If so, how is it tested, and are there any benefits available? I often experience dizziness and weakness in my limbs, and I have never been able to find the cause.
Could this be related to elevated ammonia levels? I would greatly appreciate your help in answering these questions.
Thank you!

Zhao Wang Zhen, 40~49 year old female. Ask Date: 2009/07/05

Dr. Lin Minghui reply Gastroenterology and Hepatology

Hello, elevated ammonia levels are toxic to the brain.
Normally, ammonia is produced from protein metabolism.
However, the human body has a urea cycle system to eliminate ammonia.
In children with congenital metabolic disorders, this can lead to hyperammonemia, which may present with symptoms such as vomiting and altered consciousness.
In patients with hepatic encephalopathy, ammonia concentrations can be elevated.
Improvement in hepatic coma is associated with a decrease in ammonia levels.
Poor liver function and portal hypertension can reduce the elimination of toxic ammonia and amino acids, leading to hyperammonemia and hepatic encephalopathy.
It is advisable to limit alcohol consumption, as long-term drinking can result in alcoholic liver cirrhosis, which can severely lead to hyperammonemia and hepatic encephalopathy.
Wishing you good health.
Sincerely, Dr.
Lin Ming-Hui, Taoyuan Hospital, Department of Health.

Reply Date: 2009/07/05

More Info

Elevated blood ammonia levels, known medically as hyperammonemia, can be a serious condition that may indicate underlying health issues, particularly related to liver function. Ammonia is a waste product that is normally processed by the liver and converted into urea, which is then excreted by the kidneys. When the liver is compromised, as in cases of liver disease such as alcoholic hepatitis, the body may struggle to eliminate ammonia effectively, leading to elevated levels in the bloodstream.

Causes of Elevated Blood Ammonia Levels
1. Liver Disease: Conditions like alcoholic liver disease, cirrhosis, and hepatitis can impair the liver's ability to process ammonia. Given your history of alcoholic hepatitis, this is likely a significant factor in your elevated ammonia levels.

2. Metabolic Disorders: Certain inherited metabolic disorders can affect the body's ability to process ammonia, leading to its accumulation.

3. Kidney Dysfunction: Since the kidneys are responsible for excreting urea, any dysfunction can also contribute to elevated ammonia levels.

4. Gastrointestinal Bleeding: Blood in the digestive tract can lead to increased ammonia production from the breakdown of proteins.

5. Infections: Severe infections, particularly those affecting the liver, can also lead to elevated ammonia levels.

Symptoms of Hyperammonemia
Symptoms of elevated blood ammonia levels can vary but may include:
- Neurological Symptoms: Confusion, lethargy, and altered mental status can occur as ammonia levels rise. In severe cases, this can progress to hepatic encephalopathy, which can cause coma.

- Physical Symptoms: You mentioned experiencing dizziness and weakness, which can be related to elevated ammonia levels. Other symptoms may include abdominal swelling (ascites), chest pain, and difficulty breathing, which you have reported.

- Gastrointestinal Symptoms: Nausea, vomiting, and changes in appetite can also be present.

Testing for Elevated Blood Ammonia Levels
The diagnosis of hyperammonemia typically involves:
- Blood Tests: A simple blood test can measure ammonia levels. In your case, a level of 130 µmol/L is significantly elevated, as normal levels are generally between 15-45 µmol/L.

- Liver Function Tests: These tests assess the overall health of the liver and can help identify any underlying liver disease.

- Imaging Studies: Ultrasounds or CT scans may be performed to evaluate liver structure and blood flow.

Is Hyperammonemia Rare?
Hyperammonemia itself is not a rare condition, but it is often a sign of serious underlying health issues, particularly liver dysfunction. Given your family history of liver cancer and blood cancer, it is crucial to monitor your liver health closely.

Management and Treatment
Management of elevated blood ammonia levels focuses on treating the underlying cause. In cases of liver disease, this may involve:
- Dietary Changes: Reducing protein intake can help lower ammonia production.

- Medications: Lactulose is often prescribed to help reduce ammonia levels by promoting its excretion through the intestines. Rifaximin may also be used to reduce ammonia-producing bacteria in the gut.

- Monitoring and Support: Regular follow-up with your healthcare provider is essential. They may recommend further testing or interventions based on your liver function and ammonia levels.

Conclusion
Given your medical history and elevated ammonia levels, it is crucial to work closely with your healthcare provider to manage your condition. Regular monitoring and appropriate treatment can help prevent complications associated with hyperammonemia. If you experience worsening symptoms or new neurological changes, seek immediate medical attention. Your health is paramount, and understanding these indicators can empower you to take proactive steps in your care.

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