Patient Test Information

Ammonia

Also known as:

NH3

Formal name:

Ammonia, plasma

Related tests:

Liver Panel, ALT, AST, ALP, Glucose Tests, Electrolytes, Renal Panel

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Why Get Tested?

To detect an elevated level of ammonia in the blood that may be caused by severe liver disease, kidney failure, or certain rare genetic urea cycle disorders; to help investigate the cause of changes in behavior and consciousness; to support the diagnosis of hepatic encephalopathy or Reye syndrome

When to Get Tested?

When someone with liver disease or kidney failure experiences mental changes or lapses into a coma; when a newborn experiences frequent vomiting and increased lethargy or when a child has continuous vomiting and unusual sleepiness about a week after a viral illness, such as the flu or chickenpox

Sample Required?

A blood sample drawn from a vein in your arm

Test Preparation Needed?

You should not smoke cigarettes prior to collection of the specimen.

How is it used?

The ammonia test is used to detect an elevated level in the blood that can be caused by severe liver disease, kidney failure, Reye syndrome or a rare genetic disorder of the urea cycle, for example. The test may be used to help investigate the cause of an individual's changes in behavior and consciousness.

Ammonia is a waste product naturally produced in the body. It primarily comes from the digestion of protein by bacteria in the intestines. If not processed by the liver and cleared from the body appropriately, excess ammonia can accumulate in the blood and pass from the blood into the brain, where it is toxic.

An ammonia test may be ordered, along with other tests such as glucose, electrolytes, and kidney and liver function tests, to help diagnose the cause of a coma or to help support the diagnosis of Reye syndrome or hepatic encephalopathy caused by various liver diseases. An ammonia level may also be ordered to help diagnose a rare urea cycle defect and to evaluate the severity of the condition.

For more on Reye syndrome, hepatic encephalopathy, and urea cycle disorders, see the "What is being tested?" section or the Related Pages tab.

Some healthcare practitioners use the ammonia test to monitor the effectiveness of treatment of hepatic encephalopathy, but there is not widespread agreement on its clinical utility. Since hepatic encephalopathy can be caused by the build-up of a variety of toxins in the blood and brain, blood ammonia levels correlate poorly with the severity of the condition.

When is it ordered?

An ammonia test may be ordered when a newborn has symptoms that arise in the first few days after birth, such as:

  • Irritability
  • Vomiting
  • Lethargy
  • Seizures

An ammonia test may be performed when a child develops these same symptoms about a week following a viral illness, such as influenza or chickenpox, or when a healthcare practitioner suspects that the child may have Reye syndrome.

When adults experience mental changes, disorientation, sleepiness, or lapse into a coma and may have liver disease or kidney failure, an ammonia level may be ordered to help evaluate the cause of the change in consciousness. In people with stable liver disease, an ammonia level may be ordered, along with other liver function tests, when a person suddenly becomes more acutely ill.

What does the test result mean?

A significantly increased concentration of ammonia in the blood indicates that the body is not effectively processing and eliminating ammonia and it may be the cause of the person's signs and symptoms.

In infants, an extremely high level is associated with an inherited urea cycle enzyme deficiency or defect but may also be seen with hemolytic disease of the newborn. Moderate short-lived increases in ammonia are relatively common in newborns, where the level may rise and fall without causing noticeable symptoms. (For more about urea cycle disorders, see the Related Pages tab.)

An increased ammonia level and decreased glucose level may indicate the presence of Reye syndrome in symptomatic children and teens. An increased concentration may also indicate a previously undiagnosed enzymatic defect of the urea cycle.

In children and adults, an elevated ammonia level may indicate that severe liver or kidney damage has impacted the body's ability to clear ammonia and that the brain may be affected. Frequently, an acute or chronic illness will act as a trigger, increasing ammonia levels to the point that an affected person has difficulty clearing the ammonia.

A normal blood ammonia level may mean that a person's signs and symptoms are due to a cause other than excess ammonia. However, normal concentrations of ammonia do not rule out hepatic encephalopathy. Other wastes can contribute to changes in mental function and consciousness, and brain levels of ammonia may be much higher than blood levels. This can make correlation of a person's symptoms to ammonia blood levels difficult.

A decreased level of ammonia may be seen with some types of hypertension, such as essential (high blood pressure of unknown cause) and malignant (very high blood pressure that occurs suddenly and quickly).

Is there anything else I should know?

Increased levels of ammonia may also be seen with:

  • Gastrointestinal bleeding - blood cells are hemolyzed in the intestines, releasing protein.
  • Muscular exertion - muscles produce ammonia when active and absorb it when resting.
  • Tourniquet use - ammonia levels can be increased in the blood sample collected.
  • Use of certain drugs, including alcohol, barbiturates, diuretics, valproic acid, and narcotics
  • Cigarette smoking

Decreased levels of ammonia may be seen with the use of some antibiotics, such as neomycin.

Ammonia tests can also be performed on arterial blood, but this method is much less frequently used. Some healthcare practitioners feel that arterial ammonia measurements are more clinically useful, but there is not widespread agreement on this.

What is being tested?

Ammonia is a waste product formed primarily by bacteria in the intestines during the digestion of protein. If not processed and cleared from the body appropriately, excess ammonia can accumulate in the blood. This test measures the amount of ammonia in the blood.

Ammonia is normally transported in the blood to the liver, where it is converted into two substances called urea and glutamine. The urea is then carried to the kidneys, where it is eliminated in the urine. If this "urea cycle" does not complete the breakdown of ammonia, ammonia builds up in the blood and can pass from the blood into the brain.

Ammonia is toxic to the brain. For example, when liver function is significantly reduced due to disorders such as cirrhosis or hepatitis, ammonia and other compounds processed by the liver can accumulate in the brain and cause a condition called hepatic encephalopathy.

Hepatic encephalopathy causes mental and neurological changes that can lead to confusion, disorientation, sleepiness, and eventually to coma and even death.

Infants and children with increased ammonia levels may vomit frequently, be irritable, and be increasingly lethargic. Left untreated, they may experience seizures, have difficulty breathing, and may lapse into a coma.

Problems with ammonia processing can arise from conditions such as:

  • Severe liver disease - damage limits the ability of the liver to process ammonia; spikes in ammonia blood levels may be seen in people with stable liver disease, especially following a triggering event such as gastrointestinal bleeding or an electrolyte imbalance.
  • Decreased blood flow to the liver - ammonia is less able to get to the liver to be processed.
  • Reye syndrome - a rare condition that affects the blood, brain, and liver; it is characterized by a rise in ammonia levels and a fall in glucose. It affects primarily children and young adults. In most cases, it follows and appears to be triggered by a viral infection, such as the flu or chickenpox. Children who are given aspirin are at an increased risk.
  • Renal failure - the kidneys are unable to effectively rid the body of urea, leading to a build-up of ammonia in the blood.
  • Rare inherited defects in the urea cycle - a deficiency or defect in one or more of the enzymes necessary to complete the conversion of ammonia to urea.

How is the sample collected for testing?

A blood sample is obtained by inserting a needle into a vein in the arm.

NOTE: If undergoing medical tests makes you or someone you care for anxious, embarrassed, or even difficult to manage, you might consider reading one or more of the following articles: Coping with Test Pain, Discomfort, and Anxiety, Tips on Blood Testing, Tips to Help Children through Their Medical Tests, and Tips to Help the Elderly through Their Medical Tests.

Another article, Follow That Sample, provides a glimpse at the collection and processing of a blood sample and throat culture.

Is any test preparation needed to ensure the quality of the sample?

Avoid smoking cigarettes prior to collection of the specimen and follow any other instructions you are given.

  1. Is ammonia testing used to detect or monitor ammonia poisoning?

    Not generally. In most cases, ammonia acts locally, burning or irritating whatever it comes in contact with, but according to the Agency for Toxic Substances and Disease Registry (ATSDR), it does not usually act as a systemic poison. Concentrated commercial ammonia, in a liquid or vapor form, can cause more severe burns than the more dilute liquid household ammonia, but both can damage the eyes, skin, respiratory tract, and, if swallowed, the mouth, throat, and stomach.

  2. When my increased ammonia level has returned to normal, can it rise again?

    It depends on why it was increased in the first place. If you had a temporary condition, then it is likely that the ammonia level will continue to be normal. If you have a chronic condition, then it is possible that it will increase again and your health status will likely need to be monitored. Talk to your healthcare provider about what is best for you.