What is normal serum ammonia level?

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Saunders book says 35-65mg/dL, CD 15-45, Kaplan 80-110. A bit too much difference for me.

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I'm having a really hard time finding how high serum ammonia levels need to be before you start worrying about hepatic encephalopathy. It is not in my books and I can't find it online either.

Bruce_Wayne said:
I'm having a really hard time finding how high serum ammonia levels need to be before you start worrying about hepatic encephalopathy. It is not in my books and I can't find it online either.

There are levels that are considered high, however, in 10% of hepatic encephalopathy patients, ammonia levels don't become elevated at all, so "too high" isn't really the diagnostic factor, though it can confirm what is suspected by symptoms and history. Ammonia levels can also be elevated in other diagnoses. The patients I've seen with elevated levels were given lactulose, and their levels came down with that and a low protein diet.

http://www.webmd.com/digestive-disorders/ammonia-test?page=3

http://pubs.niaaa.nih.gov/publications/arh27-3/240-246.htm

http://en.wikipedia.org/wiki/Hepatic_coma

http://emedicine.medscape.com/article/186101-overview

we actually cared for a patient in clinical 2 weeks ago with this condition. I'm under the impression that any back up of ammonia in the blood is considered hepatic encephalopathy. I found this article on the NIH website - hope it helps...

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XTX - we were posting at the same time!

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My patient today had to go to ICU, his or her condition was pretty bad and her refusal to take her lactulose for 4 days with his/her last ammonia level of 74 taken 4 days prior.

After he/she went to ICU I couldn't follow her care any more, other than seeing her blood gas on the computer and she was in metabolic acidosis.

I've just been going over my days with her over and over in my mind and wondering how I could have intervened differently.

Now he or she is intubated, last non mechanical breaths at 40 per minute.

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Specializes in ED/ICU/TELEMETRY/LTC.

It's the "pathy" part that is throwing you. If the patient has high ammonia level but has no presenting symptoms. It is not considered encephalopathy. It is the damage to the liver that has caused the high ammonia level but if the patient has no confusion or alteration of consciousness then it is not "pathy". It can very greatly from one patient to another.

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Bruce_Wayne said:
My patient today had to go to ICU, his or her condition was pretty bad and her refusal to take her lactulose for 4 days with his/her last ammonia level of 74 taken 4 days prior.

After he/she went to ICU I couldn't follow her care any more, other than seeing her blood gas on the computer and she was in metabolic acidosis.

I've just been going over my days with her over and over in my mind and wondering how I could have intervened differently.

Now he or she is intubated, last non mechanical breaths at 40 per minute.

What is the "high" on the ammonia level 'range' for the lab work.. 10-80 is the range in the links I gave you. 74 isn't "high" per that (but check the parameters on THAT labs testing) ? Hmmmmm.....no ammonia level for 4 days. Not great. That's one of those things that you'd bring to the MD's attention of you're the nurse who is assigned to that patient. By refusing the lactulose, she's killing herself. Liver failure is not a good way to go.

But DixieRedHead is correct- it's a liver issue causing the ammonia build up. Not the ammonia being the starting point of the problem- but the breakdown of the liver working that leads to the build up of ammonia, d/t not being able to break down proteins....the brain doesn't work normally when the ammonia build up makes them 'toxic'.

What other history do you have for this patient?

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