Elevated Blood Ammonia Level

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Introduction

What is an elevated blood ammonia level?

Ammonia is a nitrogen waste compound that is normally excreted in the urine. An elevated blood ammonia level is an excessive accumulation of ammonia in the blood. An elevated blood ammonia level occurs when the kidneys or liver are not working properly, allowing waste to remain in the bloodstream. Ammonia, like many other waste products in the body, can be poisonous to your cells, and an elevated blood ammonia level can affect your entire body.

Elevated blood ammonia can affect a person at any age and happens for a variety of reasons. It is fairly common in infants, in whom the disease can be related to a genetic condition. In children, it may be related to Reye’s syndrome, while in adults, an elevated blood ammonia level may indicate kidney or liver damage or an underlying metabolic disease. In some cases, an elevated blood ammonia level will resolve on its own without treatment.

In addition to an increased level of ammonia in the blood, other symptoms of elevated blood ammonia include muscle weakness, fatigue, or other symptoms of liver and kidney damage and failure. If left untreated, elevated blood ammonia can affect brain tissue, leading to symptoms such as confusion and delirium (rapid change in cognitive function).

An elevated blood ammonia level may also be related to drug or alcohol abuse. Treatment for an elevated blood ammonia level varies depending on the cause. If related to drug or alcohol abuse, treating the underlying cause may resolve the elevated blood ammonia level. Treatment includes medication, dialysis, or organ (kidney or liver) transplant.

Seek immediate medical care (call 911) if you, or someone you are with, have serious symptoms, such as sudden confusion or loss of consciousness for even a brief moment, and sudden changes in mood, personality or behavior.

Seek prompt medical care if you are being treated for elevated blood ammonia level and your symptoms recur or are persistent.

Symptoms

What are the symptoms of elevated blood ammonia level?

Symptoms of elevated blood ammonia level are related to decreased kidney or liver function. When waste products, such as ammonia, build up in the blood, they can circulate throughout the body and act as toxins. Elevated blood ammonia level is typically a progressive condition. At its onset, you may not notice any symptoms at all, or you may have only mild symptoms. As the disease worsens, you may experience more symptoms or symptoms of increased severity.

Common symptoms of elevated blood ammonia level

Symptoms of elevated blood ammonia can occur frequently, even daily, or just occasionally. At times, any of these symptoms can be severe:

Symptoms that might indicate a serious condition

In some cases, elevated blood ammonia can be a serious condition that should be immediately evaluated in an emergency setting. Seek immediate medical care (call 911) if you, or someone you are with, have any of these serious symptoms including:

  • Absent or markedly decreased urine production
  • Change in level of consciousness or alertness, such as passing out or unresponsiveness
  • Changes in mood, personality or behavior
  • Sudden confusion
Causes

What causes elevated blood ammonia?

Elevated blood ammonia may be related to a variety of conditions, including hereditary disorders or damage to the liver or kidneys. Elevated blood ammonia levels are occasionally seen in infants and children, and can be related to a hereditary condition or Reye’s syndrome (condition characterized by brain and liver swelling and dysfunction). In adults, causes vary and can include kidney or liver damage, drug and alcohol abuse, and gastrointestinal bleeding.

Causes of elevated blood ammonia level in infants and children

In infants, children and adolescents, elevated blood ammonia levels may be linked to hereditary and other disorders such as:

  • Congenital disorder of ammonia metabolism (urea cycle abnormality)

  • Hemolytic disease of the newborn (disease resulting from blood type incompatibility between mother and fetus)

  • Liver or kidney damage

  • Reye’s syndrome (condition characterized by brain and liver swelling and dysfunction)

Causes of elevated blood ammonia level in adults

In adults, elevated blood ammonia levels have been linked to:

What are the risk factors for elevated blood ammonia level?

Certain factors have been shown to increase the risk of developing elevated blood ammonia level. Not all people with risk factors will suffer elevated blood ammonia level. Risk factors for elevated blood ammonia level include:

  • Alcohol use

  • Family history of hereditary urea cycle disorders

  • Recent illness or infection

  • Smoking

  • Use of certain drugs such as barbiturates, diuretics and narcotics

Reducing your risk of elevated blood ammonia level

You may be able to lower your risk of elevated blood ammonia level by:

  • Avoiding use of drugs, alcohol and tobacco

  • Controlling your blood pressure

  • Eating a low protein diet if you have a history of liver disease

Treatments

How is elevated blood ammonia level treated?

In some cases, especially in infants, elevated blood ammonia level may be mild enough that it will resolve on its own without any treatment. In more serious cases, however, treatment is necessary because the buildup of ammonia in the bloodstream can have serious consequences. Treatment for elevated blood ammonia level is aimed at removing toxic body waste, such as ammonia, from the bloodstream. This can be accomplished through use of medications, dialysis or, in very serious cases, organ transplant.

Medical treatments for elevated blood ammonia level

There are several ways to remove excess ammonia from the blood including:

  • Dialysis (artificial filtering of the blood), using devices such as artificial livers or dialysis in a hospital setting

  • Kidney or liver transplant (in very severe cases)

  • Medications to convert ammonia into another molecule, such as L-ornithine-L-aspartate

  • Medications to reduce the amount of ammonia in the blood or gastrointestinal tract, such as special sugars (lactulose) or antibiotics (neomycin)

What are the potential complications of elevated blood ammonia level?

Because an elevated blood ammonia level is the result of waste building up in the blood stream, it can damage your internal organs or brain tissue. Complications of untreated or poorly controlled elevated blood ammonia level can be serious, even life threatening in some cases. It is very important to carefully follow your doctor’s recommended treatment plan to minimize your risk of serious complications. Complications of elevated blood ammonia level include:

  • Dementia

  • Encephalopathy

  • Organ failure, such as liver or kidney

  • Swelling (edema)

  • Unconsciousness and coma

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2019 Jan 4
  1. Ammonia. Lab Tests Online. http://www.labtestsonline.org/understanding/analytes/ammonia/test.html.
  2. Hereditary urea cycle abnormality. Medline Plus, a service of the National Library of Medicine National Institutes of Health.. http://www.nlm.nih.gov/medlineplus/ency/article/000372.htm.
  3. Bope ET, Kellerman RD (Eds.) Conn’s Current Therapy. Philadelphia: Saunders, 2013.
  4. Domino FJ (Ed.) Five Minute Clinical Consult. Philadelphia: Lippincott Williams & Wilkins, 2013.
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