In the context of advanced liver disease, elevated serum
ammonia is often a product of protein metabolism, or the lack of it. Protein, and particularly meat protein produces ammonia in the colon; and while a healthy liver can manage this, a cirrhotic liver is often incapable of removing it.
This results in ‘brain fog’, or hepatic encephalopathy. It can often be effectively managed with the drug ‘Lactulose’; a laxative that encourages frequent bowel movements.