Ammonia Laboratory research

General Information

• regionsNitrogen research is not carried out
• Research is conducted only in Tbilisi branches

Ammonia is the main product of catabolism (breakdown) of ammonium acids. Ammonia is produced as a result of the breakdown of protein under the influence of bacteria in the intestine. The liver converts ammonia into urea, which is excreted in the urine. Excretion of ammonia from the blood is a vital process because it disrupts the acid-base balance of the blood and the functioning of the central nervous system.

At physiological pH, ammonia is almost completely ionized (NH4 ⁺ ).

Hyperammonemia, that is, an increase in the level of ammonia in the blood, is caused by the disruption of nitrogen metabolism in the liver.

When is the survey conducted?

• Hepatic encephalopathy – a metabolic disorder in conditions of structural or functional damage to the liver, which leads to an increase in the concentration of toxic compounds in the blood, including ammonia. Hyperammonemia can cause changes in consciousness and even coma.
• Reye's syndrome is a rare condition that affects the brain and liver. It develops after a viral infection, more often - chicken pox and flu. Taking aspirin during a viral infection increases the risk of developing Reye's syndrome. It is common in children aged 6-15 years.
• Urea metabolism disorders are a rare genetic condition. The disease is caused by a genetic deficiency of enzymes that convert ammonia into urea. Appears shortly after birth
• Aggressive chemotherapy - often causes hyperammonemia, even without functional damage to the liver.
• Treatment with valproic acid (anticonvulsant) - disrupts liver functions, therefore it is important to control it during treatment.
• Encephalopathy and impaired consciousness due to unspecified causes

Patient preparation

The study is conducted on an empty stomach. It is advisable to limit tobacco consumption for a few hours before sampling. It is necessary to inform the doctor about the medicines you are taking. Antibiotics often cause a decrease in ammonia levels.

Note: The blood sample must be transported frozen within 2 hours of collection. In the regions, nitrogen research is not done in the blood sample.

Referral norms:

Female: 11-51 nmol/l

Man: 16-60 nmol/l

Interpretation of results

Hyperammonemia That is, an increase in the concentration of ammonia in the blood serum characterizes the following conditions:

• Severe liver diseases: necrosis, end-stage cirrhosis, hepatectomy
• Hepatic coma (research indicators do not correlate with the degree of encephalopathy)
• Reye's syndrome
• Neonatal progressive hyperammonemia (cause unknown. First 48 hours are crucial)
• Urea metabolism defects
• Chemotherapy
• Valpoate treatment
• Multiple myeloma
• Bruises in the digestive tract
• Urinary tract infection and stasis
• parenteral nutrition

Ammonia concentration in blood serum decline  It is characterized by hyperornithineemia – a condition caused by deficiency of ornithine aminotransferase. Damage to the vascular layer of the eye and the retina develops.

Ammonia levels vary according to the amount of protein consumed. Physical exertion may cause its temporary increase.

Elevated ammonia levels are caused by the liver enzyme gamma-glutamyl-transferase (GGT). increase in activity. Tightening the cuff during blood sampling may give a false hyperammonemia result.

Hemolysis causes a false increase in ammonia concentration, because the concentration of ammonia in erythrocytes is 3 times higher than its content in plasma.

Medicines that increase nitrogen levels in the blood:

Acetazolamide, asparaginase, chlorthalidone, ethacrynic acid, valproic acid, felbamate, furosemide, hydroflumethiazide, isoniazid, thiazides.

Medicines that reduce nitrogen levels in the blood:

Cefotaxime, diphenhydramine, kanamycin, lactobacilli, levodopa, MAO-inhibitors, neomycin, tetracycline, tromethamine.