There are many things going on inside our bodies, right? The things we eat and drink are digested, energy is produced, and waste is also produced. So, this ammonia is one such waste that is produced in our bodies. But if this is not excreted properly, it can cause some problems. Today, let's talk about this ammonia, why it can be dangerous, and how to control it.
What is ammonia? Simply put...
Simply put, ammonia, or (NH3), is a waste product that bacteria in our intestines produce when we digest the proteins we eat. Think of it like something left over from digesting food. So, do you know what usually happens? This ammonia goes to our liver . The liver is like a wonderful factory in our body. There, this ammonia is processed and converted into another waste product called urea . Then, this urea goes to our kidneys , where it is excreted in the urine. This whole process is called the urea cycle .
But, imagine if there is a problem in any part of this urea cycle, whether it is the liver, the kidneys, or something else that helps this process, then the ammonia is not properly processed and excreted. When that happens, the ammonia starts to accumulate in the blood. Once it accumulates, it can also go from the blood to the brain. The amount of ammonia that should be in our blood is very low . If it increases even slightly, that is, if a condition called hyperammonemia occurs, it is very toxic to our central nervous system (CNS). That is, it is dangerous.
How much ammonia should be in the body?
Now, the amount of ammonia that should be in the blood of a healthy person varies with age. Newborn babies have slightly more than adults. Also, whether the baby was born at term or early also affects it.
- Healthy term infants : About 45±9 micromoles per liter / micromol/L. Usually, the upper limit is between 80 and 90 micromol/L.
- Preterm infants : About 71±26 micromol/L. This decreases to normal levels after about seven days.
- Children older than one month : Less than 50 micromol/L.
- Adults : Less than 30 micromol/L.
But one thing to keep in mind. These values may vary slightly from lab to lab. Therefore, it is best to compare them with the values in your lab report. If you have any questions, be sure to ask your doctor or nurse.
How high is ammonia level dangerous?
Ammonia is a very toxic substance . Normally, the level of ammonia in the blood of a healthy adult is less than 50 micromoles per liter (micromol/L). However, even if this increases to just 100 micromoles per liter (100 micromol/L), changes in consciousness can begin to occur. This means that it becomes difficult to concentrate, and you may become a little confused. If the ammonia level in the blood goes as high as 200 micromol/L, you may go into a coma and have convulsions. This is very dangerous and can be life-threatening.
How to check ammonia levels in the body?
Your doctor can measure your ammonia levels with a blood test . For adults, this is usually done by taking a small amount of blood from a vein in your arm. For newborns, a doctor will clean the baby's heel, prick it with a small needle, and take a few drops of blood. Then, a small bandage is placed over the area. This is just like a regular blood test.
What are the symptoms of high ammonia levels?
If your blood ammonia levels increase, you may experience symptoms such as:
- Confusion and disorientation
- Excessive sleepiness, difficulty waking up
- Changes in consciousness, sometimes even loss of consciousness
- Mood swings, irritability, and mood swings
- Hand tremors, especially when extending the arm forward
- Coma - A state of unconsciousness and unresponsiveness
This is very important: if you or someone close to you has these symptoms, do not waste time and call the ambulance service 1990, or go to the emergency department of the nearest hospital as soon as possible. Increased ammonia levels can be life-threatening, so immediate medical attention is necessary.
Symptoms of a newborn baby
If a newborn baby shows any of these symptoms in the first few days after birth, a doctor may test for ammonia levels:
- Constant restlessness, frequent crying, and unwillingness to drink milk (Irritability)
- Vomiting
- Drowsiness, lethargy, difficulty waking up
- Seizures
If a baby has these symptoms, don't ignore them. See a doctor immediately.
Why do ammonia levels in the body increase so much?
There are several reasons why ammonia levels in the blood can increase. Let's take a look at what they are:
- Liver disease: This is the most common cause . If your liver is damaged, such as with cirrhosis, the liver can't properly clear ammonia. This is often the case with severe liver disease. However, sometimes, even if your liver disease is stable, if something like gastrointestinal bleeding or an electrolyte imbalance occurs, ammonia levels can suddenly rise.
- Reduced blood flow to the liver: If the liver doesn't get enough blood, ammonia has no way to get to the liver and be cleaned. Then, ammonia builds up in the blood.
- Hepatic encephalopathy: This is a bit more complicated. Simply put, when the liver is diseased or damaged and cannot properly clear ammonia, ammonia builds up in the blood and travels to the brain. This can cause disorientation, confusion, and coma. It can sometimes be fatal.
- Reye's syndrome: This is a rare but very serious condition that affects the blood, brain, and liver. It usually causes high blood ammonia levels and low blood glucose levels. It most often occurs in children and young adults who have taken aspirin for symptoms while recovering from a viral illness such as chickenpox or influenza (flu). The exact cause of Reye's syndrome is not known. However, because of this risk, children and young adults should not take aspirin unless specifically recommended by a doctor.
- Kidney / renal failure: If your kidneys are not working properly, meaning they are failing, they cannot properly remove urea. This causes ammonia to build up in the blood.
- Genetic diseases of the urea cycle: There are very rare genetic diseases. These are caused by an inborn deficiency of one of the enzymes required for the urea cycle. 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 your baby's Rh-positive cells.
What are the treatments for elevated ammonia levels?
Treatment for elevated ammonia levels depends on the cause. For example, in an adult, it could be due to liver disease or hepatic encephalopathy, while in a newborn, it could be due to a congenital condition that disrupts the urea cycle.
When treating acute hyperammonemia, the main focus is on reducing ammonia levels and controlling complications such as cerebral edema and intracranial hypertension.
If a newborn's ammonia level increases, doctors stop giving them protein (because ammonia is produced when protein is digested). Instead, they give them glucose solutions to provide energy. They also use a treatment called hemodialysis to remove ammonia from the baby's blood. This involves cleaning the blood using a special machine called a dialysis machine and a filter, such as an artificial kidney.
When treating hepatic encephalopathy, the goal is to reduce the production of ammonia in the intestines. The first line of treatment is oral medications called lactulose and lactitol . These sugars reduce the production and absorption of ammonia in the intestines.
When should I see a doctor about my ammonia levels?
This is very clear. If you or someone close to you is experiencing symptoms of high blood ammonia levels, such as the disorientation we talked about earlier, constant drowsiness, and changes in consciousness, call 911 immediately, or go to the nearest hospital emergency room as soon as possible. This is not something to delay.
If you have liver disease, you should see your doctor regularly to make sure your liver is clearing ammonia properly. This will help you identify any problems early.
So, what are the most important things we need to remember from this story?
Although it is normal for our bodies to produce ammonia as a waste product, it can be very dangerous if it accumulates in the blood in excess.
If you or someone close to you has symptoms of high ammonia levels (for example, confusion, excessive sleepiness, behavioral changes), go to the nearest hospital as soon as possible without delay. This can be a life-or-death situation.
It is especially important to be aware of these symptoms if you have liver disease, as this can increase the risk of elevated ammonia levels.
If you have any questions about the risk of elevated ammonia levels, or anything else you would like to know, don't hesitate to talk to your doctor. They are there to help you and answer your questions. Staying healthy is the most important thing!
` Ammonia, Ammonia Levels, Liver, Kidney, Urea Cycle, Hepatic Encephalopathy, Reye's Syndrome, Blood Test, Hyperammonemia
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