Ken & HE/Ammonia

[Guest guest]

Ken’s labs are due 1/19, so I e-mailed his coordinator

to send in the order. His ammonia

level hasn’t been checked since June, so I asked if they would include it.

We were surprised to learn Dr

(Director of Hepatology at Baylor & member of the transplant team) doesn’t

recommend testing for ammonia – even for those listed. I asked why, and was told a person could

have HE with normal ammonia levels or have severe HE with just a little rise in

ammonia, so it was a lousy indicator of HE. She also said; many things influence ammonia

levels, things as simple as eating too much protein, muscular exertion (exercising),

improper or too long tourniquet use, sweat getting into the blood draw etc, can

all raise ammonia levels. She said

a person has to have cirrhosis or be in the end stage so testing for it before

then was useless too. I asked her;

when do they use it? She said, when

people with HE use Lactulose they test to see if the medicine is actually removing

toxins. So I did some checking…..

seems they are right, sure came as a surprise to me. Here are a few tidbits-

“Some

doctors 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 degree of impairment”.

“The most commonly used laboratory test in HE

is the venous ammonia level. Because of inconsistent

elevation and lack of correlation with the stage of encephalopathy, the ammonia

level is not considered a good screening tool. “

Palmer: “Encephalopathy is an altered

or impaired mental status, typically leading to coma, that can occur in people

with cirrhosis”. However,

since some studies have demonstrated a poor

correlation between ammonia levels and degree of encephalopathy, its use for

this purpose is controversial. Measurement of the ammonia level in

people with liver disease is not recommended, as mild increases may occur with any liver disease

and are not diagnostic of encephalopathy. Finally,

there are multiple factors which can artificially elevate ammonia levels,

thereby skewing interpretability.

I learn something new every day,

Barb in Texas

[Guest guest]

Well, now isn’t that interesting…so

why can’t we treat the boy with “little people crawling all over

him”? This is so frustrating to me.

Thank you for posting this Barb.

Mom of Zoe

(13) super soccer player;

Noah (9) UC,

PSC, enthesopathy and osteopenia and a great soccer and basketball player and;

Aidan (5)

moderately-severely hearing impaired great basketball shot (10-foot

hoop none-the-less)

[Guest guest]

Barb,

This is very informative information…thanks for

sharing and helping me to learn something new everyday. Question for

you: You mentioned, “She said a person has to have cirrhosis or be in the

end stage so testing for it before then was useless too.” was this in

regards to HE or ammonia levels?

Together in the fight…Whatever it takes!!!

Joanne (mom of Todd)