Ammonemia


Ammonemia

Description, Causes and Risk Factors:

The presence of ammonia or some of its compounds in the blood, thought to be formed from the decomposition of urea; it usually results in subnormal temperature, weak pulse, gastroenteric symptoms, and Coma.

Ammonia (NH3) or its ion form ammonium (NH4+) is an important source of nitrogen for living systems. It is synthesized through amino acid metabolism and is toxic when present at high concentrations. In the liver, ammonia is converted to urea through the urea cycle. Elevated levels of ammonia in the blood (hyperammonemia) have been found in liver dysfunction (cirrhosis), while hypoammonemia has been associated with defects in the urea cycle enzymes (e.g. Ornithine transcarbamylase).

Ammonemia

Ammonia is produced when your body breaks down the protein you consume, and if you have a urea cycle disorder, your ammonia levels will fluctuate. A healthy liver converts the ammonia in your body into urea, which is expelled in your urine. If the liver is unable to change ammonia to urea, your ammonia levels can rise to unhealthy levels, requiring treatment.

The exact cause of ammonemia is not known, it is believed to be due to deficiency of the enzyme carbamoyl phosphate synthetase I and ornithine carbamoyltransferase.

Possible risk factors:

    Liver disease, such as cirrhosis or hepatitis.

  • Reye syndrome.

  • Kidney failure.

  • Severe bleeding from the stomach or intestines.

  • Cardiovascular diseases.

Blood ammonia concentration increases during endurance exercise and has been proposed as a cause for both peripheral and central fatigue. Subjects were examined for the impact of glutamine and (or) carbohydrate supplementation on ammonemia in high-level runners. Fifteen men in pre-competitive training ran 120 min (approximately 34 km) outdoors on 4 occasions. On the first day, the 15 athletes ran without the use of supplements and blood samples were taken every 30 min. After that, each day for 4 d before the next 3 exercise trials, we supplemented the athletes' normal diets in bolus with carbohydrate and glutamine or a combination of both in a double-blind study. Blood ammonia level was determined before the run and every 30 min during the run. During the control trial ammonia increased progressively to approximately 70% above rest concentration. Following supplementation, independent of treatment, ammonia was not different (p>0.05) for the first 60 min, but for the second hour it was lower than in the control (p<0.05). Supplementation in high-level, endurance athletes reduced the accumulation of blood ammonia during prolonged, strenuous exercise in a field situation.

Symptoms:

The presence of ammonia or some of its compounds in the blood, thought to be formed from the decomposition of urea; it usually results in subnormal temperature, weak pulse, gastroenteric symptoms, and Coma. Neurological symptoms may include confusion, excessive sleepiness, tremors, etc.

Diagnosis:

Diagnosis may include ammonia test:

    An ammonia test measures the amount of ammonia in the blood. Most ammonia in the body forms when protein is broken down by bacteria in the intestines.

  • Check how well the liver is working, especially when symptoms of confusion, excessive sleepiness, coma, or hand tremor are present.

  • Help identify a childhood disorder called Reye's syndrome that can damage the liver and the brain.

  • Check the level of ammonia in a person receiving high-calorie intravenous (IV) nutrition (hyperalimentation).

Treatment:

Treatment is usually balancing dietary protein intake in order that the body receive the essential amino acids responsible for cell growth and development, but not so much protein that excessive ammonia is formed. This protein restriction is used in conjunction with medications which provide alternative pathways for the removal of ammonia from the blood. These medications are usually given by way of tube feedings, either via gastrostomy tube (a tube surgically implanted in the stomach) or nasogastric tube through the nose into the stomach. The treatment may also include supplementation with special amino acid formulas developed specifically for ammonemia, multiple vitamins and calcium supplements. Frequent blood tests are required to monitor the disorders and optimize treatment, and frequently hospitalizations are necessary to control the disorder.

At the most extreme end of the spectrum, a few liver transplants have been done successfully as a cure to the disorder. This treatment alternative must be carefully evaluated with medical professionals to determine if potential of success as compared to the potential for new medical concerns.

NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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