What is your ammonia level? Let's be aware of this!

We all have a lot of things going on inside our bodies, right? Some things we are aware of, some things we don't even think about. That's how we are. Ammonia is something that is produced inside our bodies as we go about our daily activities , but can cause problems if not managed properly. So, today we will talk about what ammonia is, what happens if it increases in the body, and what we should do about it.

What is ammonia? Why is it important to us?

Simply put, ammonia, a gas chemically known as `(NH3)`, is a waste product that is produced in our bodies. To be precise, it is mainly produced by bacteria in our intestines when we digest the proteins we eat. Now think about it, just as we get rid of a lot of garbage when it accumulates, the body also needs to get rid of this ammonia.

This job is mainly done by our liver. What the liver does is take this ammonia and turn it into another waste product called urea. We call this process the urea cycle . Then this urea goes to our kidneys, where it is excreted in the urine. It's a pretty amazing system, isn't it?

However, if there is a problem in any part of this process, whether it is the liver, the urea cycle, or the kidneys, ammonia is not removed from the body properly. Then what happens is that this ammonia starts to accumulate in the blood. Once it accumulates, it can also go from the blood to the brain. The level of ammonia in our blood should be very low. If it increases even slightly, we call it hyperammonemia , which can affect our central nervous system ( It is very toxic to the central nervous system (CNS), that is, the brain and spinal cord. It is like when a chimney in a house is clogged, the house fills with smoke.

So, what is the normal level of ammonia in the body?

This is a very important question. In fact, the normal amount of ammonia in the blood varies with age. This level is slightly higher in newborn babies than in older children or adults. Even in newborn babies, these levels can vary depending on the number of weeks they were born (gestational age) and the number of days that have passed since birth (postnatal age).

Let's look at some generally accepted values. These are measured in units called micromoles per liter (micromol/L).

• Healthy term infants : About 45±9 `micromol/L`. Usually, between 80 and 90 `micromol/L` is considered the upper limit.
• Preterm infants: About 71±26 `micromol/L`. However, after about seven days, this number decreases and reaches the level of a full-term baby.
• Children older than one month: Should be less than 50 `micromol/L`.
• Adults : Should be less than 30 `micromol/L`.

Important: These values ​​may vary slightly from lab to lab. So, be sure to check the reference range on your report. If you have any questions, be sure to ask your doctor.

How high does ammonia level become toxic?

Ammonia is a very toxic substance. As mentioned earlier, the level of ammonia in the blood is usually less than 50 `micromol/L` (varies with age). Imagine, even if this increases to only 100 `micromol/L`, changes in consciousness can begin to occur. That is, people can suddenly become confused, lose their bearings, etc. If the level of ammonia in the blood goes as high as 200 `micromol/L`, it can lead to coma and severe conditions such as convulsions. So this is not something to play with.

How to check ammonia levels in the body?

Your doctor can measure your ammonia levels by taking a blood sample ( blood test ). For adults, this is usually done by taking a small amount of blood from a vein in your arm using a small needle.

For a newborn baby, a doctor or nurse will clean the skin on the baby's heel, prick it with a small needle, and collect a few drops of blood. Then, a small bandage will be placed over the area. This is a routine test for babies.

What are the symptoms of high ammonia levels?

When ammonia levels in the blood increase, a number of symptoms can occur. It is important to be aware of these.

• Confusion and disorientation : This means that you can't concentrate, and you forget things like where you are and what time it is.
• Excessive sleepiness: Not just sleepiness that comes from being tired, but unusually sleepy all the time, making it difficult to wake up.
• Changes in consciousness: Sometimes consciousness decreases, and even speech becomes slurred.
• Mood swings: Rapid changes in mood, such as suddenly becoming angry or sad.
• Hand tremors: Uncontrollable shaking of the hands.
• Coma: In the most severe cases, unconsciousness may occur.

Warning: If you or someone you know has one or more of these symptoms, call 911 (or your local emergency number) immediately, or go to the nearest emergency room. High ammonia levels can be life-threatening, so seek immediate medical attention!

If a newborn baby shows any of these symptoms within the first few days of birth, a doctor may test for ammonia levels:

• Frequent crying, irritability
• Vomiting
• Lethargy
• Seizures

Don't panic if you see any of these symptoms, but it's best to see a doctor.

Why does ammonia level increase in the body? What are the causes?

There can be several reasons why ammonia levels increase. Let's look at the main ones.

• Liver disease: When the liver is damaged, its ability to clear ammonia is reduced. This is most common in severe liver disease. However, sometimes, even if the liver disease is under control, ammonia levels can suddenly rise if there is sudden gastrointestinal bleeding or an electrolyte imbalance. The most common cause of elevated ammonia levels is liver disease.
• Decreased blood flow to your liver: If your liver doesn't get enough blood, your body can't send ammonia to the liver to be cleaned. Even then, ammonia builds up in your blood.
• Hepatic encephalopathy: This occurs when the liver is diseased or damaged and cannot properly clear ammonia. The ammonia that builds up in the blood then travels to the brain. This can cause confusion, loss of consciousness, coma, and sometimes even death.
• Reye's syndrome: This is a very rare condition. It affects the blood, brain, and liver. It usually causes high levels of ammonia in the blood and low levels of glucose in the blood. It most commonly affects children and young adults who are recovering from viral infections such as chickenpox or influenza, and who have taken aspirin to control symptoms. The exact cause of Reye's syndrome is not known. However, because of this risk, aspirin should not be given to children and young adults unless specifically recommended by a doctor.
• Kidney (renal) failure: If the kidneys fail and cannot properly excrete urea, it can also cause ammonia to accumulate in the blood.
• Genetic diseases of the urea cycle: Some very rare genetic diseases can cause a deficiency in an enzyme in the urea cycle that converts ammonia into urea. This is usually detected at birth.
• Hemolytic disease of the newborn: This happens when a pregnant mother makes antibodies against her baby's blood cells. This condition can be prevented. If you are `(Rh-negative)` and have not been previously sensitized, you can take a medicine that stops your antibodies from reacting with the baby's `(Rh-positive)` cells.

How to treat high ammonia levels?

The treatment for elevated ammonia levels depends on the cause, for example, whether it is due to liver disease or hepatic encephalopathy in an adult, or a congenital problem with the urea cycle in a newborn.

In acute hyperammonemia, the main focus is on reducing ammonia levels and controlling complications such as cerebral edema and increased pressure around the brain (intracranial hypertension).

If a newborn baby's ammonia level increases, doctors first stop giving them protein (because ammonia is produced when protein is broken down). Then they give them glucose solutions to provide the body with the calories it needs. They also use a method called hemodialysis to remove ammonia from the baby's blood. This involves cleaning the blood through a special filter, such as a dialysis machine and an artificial kidney.

When treating hepatic encephalopathy, the goal is to reduce the production of ammonia in the intestines. The first-line treatment is oral medications. Examples of these are sugars called lactulose and lactitol . These reduce the production and absorption of ammonia in the intestines.

When should I see a doctor about my ammonia levels?

As mentioned earlier, if you or someone you know has symptoms of high blood ammonia, such as confusion, excessive sleepiness, etc., call 911 (or your local emergency number) immediately, or go to the nearest hospital emergency room. This is not something to put off.

If you have liver disease, you should see a doctor regularly to make sure your liver is properly clearing ammonia.

So, what are the most important things we should remember from this story? (Take-Home Message)

Okay, we've talked a lot about ammonia, haven't we? To summarize:

• Ammonia is a waste product that builds up in our bodies. If it is not removed properly, it can cause problems.
• Our liver is the main one that purifies ammonia and converts it into urea.
• Increased levels of ammonia in the blood, a condition called hyperammonemia, are very harmful and toxic to the brain.
• Normal ammonia levels vary depending on age. Newborns have slightly higher levels.
• If you experience symptoms such as confusion, excessive sleepiness, changes in consciousness, or tremors , it could be a sign of high ammonia levels. If this happens, seek medical advice immediately.
• Things like liver disease, kidney disease, certain genetic conditions, and Reye's syndrome can cause elevated ammonia levels.
• Treatment varies depending on the cause. Early treatment can save lives.
• Be especially aware of these symptoms if you have liver disease.

Although our bodies actually produce ammonia as a waste product, it can be very dangerous if it builds up in the blood. If you or a loved one has symptoms of high ammonia levels, go to the nearest hospital as soon as possible. If you have any questions about the risks of high ammonia levels, talk to your doctor. They are there to help you.

Got it? I hope this information is useful to you. Stay healthy!

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