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To detect an elevated level of ammonia in the blood that may be caused by severe liver disease, kidney failure, or certain rare genetic disorders; to help investigate the cause of changes in behavior and consciousness; to help diagnose hepatic encephalopathy or Reye syndrome
When someone with or without 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 during recovery from a viral illness, such as the flu or chickenpox
A blood sample drawn from a vein
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:
The ammonia test is used to detect an elevated level in the blood. It may be ordered, along with other tests such as glucose, electrolytes, and kidney and liver function tests, to investigate the cause of changes in your behavior and consciousness or to help support the diagnosis of Reye syndrome or hepatic encephalopathy caused by various liver diseases.
Some healthcare practitioners use the ammonia test to monitor the effectiveness of treatment of hepatic encephalopathy, but there is not widespread agreement on this use. 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.
An ammonia level may also be ordered to help diagnose certain rare genetic disorders. For example, it may be used to diagnose a urea cycle defect, to evaluate the severity of the urea cycle impairment in this condition, and also to monitor treatment.
For more on Reye syndrome, hepatic encephalopathy, and urea cycle disorders, see the links in the Related Content section below.
An ammonia test may be order when you experience signs and symptoms of an elevated ammonia level, such as:
The above symptoms can occur with and without liver disease or kidney failure. In you have stable liver disease, an ammonia level may be ordered, along with other liver function tests, when you suddenly become acutely ill.
An ammonia test may be ordered when a newborn has signs and symptoms that arise in the first few days after birth, such as:
An ammonia test may be performed when a child develops these same symptoms during recovery from a viral illness, such as influenza or chickenpox, to rule out Reye syndrome.
A significantly increased level of ammonia in the blood indicates that your body is not effectively processing and eliminating ammonia and it may be the cause of your signs and symptoms.
In children and adults, an elevated ammonia level may indicate that severe liver or kidney damage has affected 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.
In infants, high levels might indicate impairment of the urea cycle due to a rare genetic disorder such as a deficiency of one of the urea cycle enzymes, or may also be seen with hemolytic disease of the newborn. Moderate, temporary 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 links in the Related Content section below.)
An increased ammonia and low glucose in combination with elevated levels of certain liver enzymes may indicate the presence of Reye syndrome in symptomatic children and teens. An increased level may also indicate a previously undiagnosed enzymatic defect of the urea cycle.
A normal blood ammonia level may mean that your signs and symptoms are due to a cause other than excess ammonia. However, normal levels of ammonia do not rule out hepatic encephalopathy. Other breakdown products 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 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).
Increased levels of ammonia may also be seen with:
Decreased levels of ammonia may be seen with the use of some antibiotics, such as neomycin and metronidazole.
Ammonia tests can also be performed on blood from an artery, but this is much less common than using blood from a vein. Some healthcare practitioners feel that arterial ammonia measurements are more clinically useful, but there is not widespread agreement on this.
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.
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.
Sources Used in Current Review
Tatiana Yuzyuk, PhD, FACMG, University of Utah, ARUP.
Häberle J (2013). Clinical and biochemical aspects of primary and secondary hyperammonemic disorders. Arch Biochem Biophys. 2013 Aug 15;536(2):101-8.
LaBuzetta JN et al (2010). Adult nonhepatic hyperammonemia: a case report and differential diagnosis. Am J Med. 2010 Oct;123(10):885-91.
Sakusic A et al (2018). Features of Adult Hyperammonemia Not Due to Liver Failure in the ICU. Crit Care Med. 2018 Sep;46(9):e897-e903.
Reye's Syndrome Information Page. National Institute of Neurological Disorders and Stroke. Available online at https://www.ninds.nih.gov/Disorders/All-Disorders/Reyes-Syndrome-Information-Page. Accessed on 6/24/19.
Tapper EB, Jiang ZG, Patwardhan VR (2015). Refining the ammonia hypothesis: a physiology-driven approach to the treatment of hepatic encephalopathy. Mayo Clin Proc. May;90(5):646-58.
Wijdicks EF. (2016) Hepatic Encephalopathy. N Engl J Med. 2016 Oct 27;375(17):1660-1670.
Häberle J et al. (2019) Suggested guidelines for the diagnosis and management of urea cycle disorders: First revision. J Inherit Metab Dis. 2019 Apr 14.
Sources Used in Previous Reviews
Pagana, Kathleen D. & Pagana, Timothy J. (© 2007). Mosby's Diagnostic and Laboratory Test Reference. 8th Edition: Mosby, Inc., Saint Louis, MO. Pp 52-53.
Clarke, W. and Dufour, D. R., Editors (2006). Contemporary Practice in Clinical Chemistry. AACC Press, Washington, DC. Pp 270.
Wu, A. (2006). Tietz Clinical Guide to Laboratory Tests. Fourth Edition. Saunders Elsevier, St. Louis, Missouri. Pp 98-99.
Lehrer, J. (2006 October 13). Hepatic encephalopathy. MedlinePlus Medical Encyclopedia [On-line information]. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/000302.htm. Accessed on 2/17/08.
(2006 September, Updated). Recommended Newborn Screening Tests: 29 Disorders. March of Dimes [On-line information]. Available online through http://www.marchofdimes.com. Accessed on 12/17/08.
Alerif, L. (2008 January 22, Updated). Hereditary urea cycle abnormality. MedlinePlus Medical Encyclopedia [On-line information]. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/000372.htm. Accessed on 2/17/08.
Van Voorhees, B. (2006 August 18). Reye syndrome. MedlinePlus Medical Encyclopedia [On-line information]. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/001565.htm. Accessed on 2/17/08.
Hepatocerebral degeneration. MedlinePlus Medical Encyclopedia [On-line information]. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/001393.htm. Accessed on 2/17/08.
(© 2005). What is a Urea Cycle Disorder? National Urea Cycle Disorders Foundation [On-line information]. Available online through http://www.nucdf.org/ucd.htm. Accessed on 2/17/08.
KidsHealth, Nemours Foundation. Infections: Reye Syndrome (online information). Available online through http://kidshealth.org. Accessed March 2008.
S. Bakerman (2002). Bakerman's ABCs of Interpretive Laboratory Data (4th ed), Interpretive Laboratory Data, Scottsdale, AZ, Pp. 44-45.
Thomas, Clayton L., Editor (1997). Taber's Cyclopedic Medical Dictionary. F.A. Davis Company, Philadelphia, PA [18th Edition].
(© 2004) Ammonia. ARUP's Guide to Clinical Laboratory Testing [On-line information]. Available online at http://www.aruplab.com/guides/clt/tests/clt_al50.jsp.
(2004, May 24, Updated). Medical Management Guidelines (MMGs) for Ammonia (NH3). Agency for Toxic Substances and Disease Registry [On-line information]. Available online through http://www.atsdr.cdc.gov.
Miller, K. (2003 October 1). Do Ammonia Levels Correlate with Hepatic Encephalopathy? American Family Physician, Tips from Other Journals [On-line journal]. Available online through http://www.aafp.org.
Johnston, D. (1999 April 15). Special Considerations in Interpreting Liver Function Tests. American Family Physician [On-line journal]. Available online through http://www.aafp.org.
(© 1995-2004). Portal-Systemic Encephalopathy (Hepatic Encephalopathy; Hepatic Coma). The Merck Manual of Diagnosis and Therapy, Section 4. Hepatic And Biliary Disorders, Chapter 38. Clinical Features Of Liver Disease [On-line information]. Available online through http://www.merck.com.
(© 1995-2004). Liver Encephalopathy. The Merck Manual Second Home Edition, Section 10. Liver and Gallbladder Disorders, Chapter 135. Clinical Manifestations of Liver Disease [On-line information]. Available online through http://www.merck.com.
(© 1998-2003). Understanding the Basics, What is a Urea Cycle Disorder? National Urea Cycle Disorders Foundation [On-line information]. Available online through http://www.nucdf.org.
Burnett, R. (2002 September). September 2002 Q & A. College of American Pathologists [On-line information]. Available online through http://www.cap.org.
Mayo Clinic staff (2004 February 18). Reye's syndrome. MayoClinic.com [On-line information]. Available online through http://www.mayoclinic.com.
National Academy of Clinical Biochemistry. Laboratory Guidelines for Screening, Diagnosis and Monitoring of Hepatic Injury (2000). Available online through http://www.nacb.org.
Pagana K, Pagana T. Mosby's Manual of Diagnostic and Laboratory Tests. 4th edition. Pp 58-60.
ARUP Lab Tests. Ammonia, Plasma. Available online at http://www.aruplab.com/guides/ug/tests/0020043.jsp. Accessed October 2011.
MedlinePlus Medical Encyclopedia. Essential hypertension. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/000153.htm. Accessed October 2011.
MedlinePlus Medical Encyclopedia. Malignant hypertension. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/000491.htm. Accessed October 2011.
Elgouhari, HM. Q: What is the utility of measuring the serum ammonia level in patients with altered mental status? Cleveland Clinic Journal of Medicine. Available online at http://www.ccjm.org/content/76/4/252.full. Accessed October 2011.
Chawla, J. (2015 Nov 30). Hyperammonemia. Medscape Drugs & Diseases [On-line information]. Available online at http://emedicine.medscape.com/article/1174503-overview. Accessed February 2016.
De Biase, Irene et. al. (2016 Jan Updated). Mitochondrial Diseases. ARUP Consult [On-line information]. Available online at http://www.arupconsult.com/Topics/MitochondrialDz.html?client_ID=LTD. Accessed February 2016.
Haldeman-Englert, C. (2014 February 3, Updated). Hereditary urea cycle abnormality. MedlinePlus Medical Encyclopedia [On-line information]. Available online at https://www.nlm.nih.gov/medlineplus/ency/article/000372.htm. Accessed February 2016.
(2014 November 6 Updated). Roth, K. Genetics of Hyperammonemia. [On-line information]. Available online at http://emedicine.medscape.com/article/944996-overview. Accessed February 2016.
Devaraj, S. (2013 October 21, Updated). Ammonia. Medscape Drugs & Diseases [On-line information]. Available online at http://emedicine.medscape.com/article/2054408-overview. Accessed February 2016.
Dugdale, D. (2015 February 8 Updated). Ammonia – blood. MedlinePlus Medical Encyclopedia [On-line information]. Available online at https://www.nlm.nih.gov/medlineplus/ency/article/003506.htm. Accessed February 2016.
Henry's Clinical Diagnosis and Management by Laboratory Methods. 22nd ed. McPherson R, Pincus M, eds. Philadelphia, PA: Saunders Elsevier: 2011, Pg 299.
Tietz Textbook of Clinical Chemistry and Molecular Diagnostics. Burtis CA, Ashwood ER, Bruns DE, eds. 4th edition, St. Louis: Elsevier Saunders; 2006, Pp 1789-1791.
(August 12, 2014) Mayo Clinic. Reye's Syndrome. Available online at http://www.mayoclinic.org/diseases-conditions/reyes-syndrome/basics/definition/con-20020083. Accessed Feb 2016.