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Ammonia 23/3/11 A-Z E-medicine - NH3 colourless pungent-smelling gas highly water soluble produced from protein, amino acid and glutamine break down toxic to human cells normal range: 100-200 mg/L - produced: (1) GIT – enteric organisms on dietary proteins and amino acids (2) liver – detoxified to urea (3) renal – in proximal tubule from glutamine break down (combines with H+ -> NH4+ and eliminated) CAUSES OF HYPERANMONIUMAEMIA - glycine intoxication (TURP or hysteroscopy syndrome) liver disease (any cause) porto-systemic shunt drugs: valproate, topiramate, chemotherapy, salicyclates UTI with a urea producing organism (Proteus mirabilus, Staphylococcus) rare genetic disorders (ornithine carbamoyl-transferase deficiency) CLINICAL FEATURES - tremor slurred speech blurred vision coma dehydration tachypnoea INVESTIGATIONS - plasma ammonium ABG – metabolic acidosis glucose lactate urinary and plasma ketones CT: cerebral oedema MANAGEMENT - treat cause! Jeremy Fernando (2011) - decreased intake: nutrition with low protein - increased elimination: haemodialysis, drugs to lower ammonium level (sodium benzoate, sodium phenylacetate, sodium phenylbutyrate) - liver transplantation Jeremy Fernando (2011)
