ammonia levels in the brain

He was just told he needed to be on a no protein diet and is taking the lactulose. The last time he was in the hospital his ammonia level was 250. He was not responding to anyone and it mimicked a stroke. He received IV therapy and a blood transfusion at this time also. Would increasing his lactulose on the onset of increased confusion (he is always slightly confused now) help clear some more of the ammonia out?

Hi Jugs— I’m sorry to hear about you uncle’s condition; I hope he recovers soon. Ammonia levels only require monitoring in the presence of decompensated cirrhosis; only about 5% of Hep C patients will progress to this point. It is not required to check plasma ammonia testing in the vast majority of HCV patients. Out of curiosity, what inspired you to discuss this with the medical staff in the first place?

By using lactulose and rifaximin in the proper amounts the levels of ammonia and other toxins are reduced. The ammonia is created when food such as animal protein is not being digested properly. The rifaximin modifies the breakdown of food in the intestine. Lactulose keeps the digested food from staying in the intestines and creating ammonia and other toxins. I have had various levels of HE and when my mind is clear I can think as well as ever. Many friends have been comatose from HE.

The pathogenesis (cause) of hepatic encephalopathy is complex and not completely defined, but it is clear that nitrogenous wastes, particularly ammonia, derived from the gut play a major role in the observed disruptions of brain function. Bacteria residing in the large bowel (colon) produce ammonia that is absorbed into the bloodstream leading to the liver.

The liver normally converts ammonia into urea, which is then eliminated in urine. Ammonia levels in the blood rise when the liver is not able to convert ammonia to urea. This may be caused by cirrhosis or severe hepatitis. Take enough lactulose to have 3-4 bowel movements per day and your ammonia level will drop and you will feel better. Normal is 15-60 mcg/dL. It usually that a day or a couple of days for the ammonia levels to drop. I am not sure of your health status.

Will I have had elevated ammonia levels a couple of times in the past few years, and yes I could tell with certainty when it occurred. Not sure if "smell" is the right word for me but I knew when the levels were elevated. There is a blood test to confirm this. Ask you doc. Also take lactulose or rifaximin to reduce ammonia levels. Reduce animal protein intake. There is a definite correlation between brain fog/HE and elevated ammonia levels.

the brain damage caused by high ammonia levels not to mention accelerated liver damage are not what you want either right? I think the better part of valor is to tolerate the taste so that you can keep your wits about you...unless dymentia, brain fog and liver failure sound good to you.

Some people with Stage 4 (cirrhosis) can develop excess accumulation of ammonia due to compromised liver function, which can in turn cause confusion and disorientation. Damage to the liver caused by hep c can lead to too much ammonia in the blood which then affects the brain, a condition called encephalopathy.

The last two days I have been more wakeful still having alittle trouble with mobility.I walk like I'm drunk at times,I guess it goes just fine with thinking like one!Ha! My ammonia levels were very high.Taking the dreaded Lactulose 45 ml's3 times per day.It isn't working as well as it should maybe I am thinking because of the water I am unable to drink and the sodium. This all started because I limited my sodium intake so much that I wiped it out with my water drinking.

The Rifaximin works by cleaning any gut bacteria which decreases the amount of ammonia in the body which limits the amount that can cross the blood brain barrier thereby reducing the risk of encephalopathy and the neuro related symptoms.

At some point tonight the doctor is going to try to wake him from the coma in order to speak with a couple family members (also, what is the realistic hope of this wake-up attempt being successful?). I'm aware I might sound a bit pessimistic, but he's already outlived his prognosis by 2-3 times. I just want to know what to expect.

However if you choose a diet rich in fiber you may be able to skip that. It will depend on your ammonia levels which a blood test will reveal. You need to get to 3 good bowel movememnts a day to keep blood ammonia down, which is the largest cause of brain fog. If you treat for hep C with SOC you should also see a drop in this problem as your liver returns to normal function and enymes levels.

Since not all persons with cirrhosis are affected by elevated ammonia levels what’s the point in the test? Some persons are greatly affected with slightly elevated ammonia levels while others with experience no symptoms of hepatic encephalopathy with high ammonia levels or vice versa. Seeming that the test is irrelevant or at least this is the way of thinking by my hepatologist during my most recent visit to the transplant center in my area. So why do we even talk about it?

I’ve read other posts where people talk about ammonia levels in the hundreds and I’m really confused. How high can they get? How high before you go into a coma? He is only 65.

THIS IS THE INFO I HAVE BEEN GIVEN CONCERNING AMMONIA LEVELS. NORMAL IS 80 AND UNDER. MY AMMONIA HAS BECOME ELEVATED AS HIGH AS 800. WHEN MY AMMONIA BECOMES ELEVATED, ENCEPHALOPATHY SETS IN. THIS CAUSES ME TO BECOME CONFUSED, DISORIENTED, AND UNSTEADY ON MY FEET. THIS IS USUALLY THE POINT WHERE I END UP IN THE HOSPITAL.

If the liver is decompromised it cannot metabolize the waste products hence there is an elevation of blood ammonia levels resulting in increased excretion in the urine. Also, increased levels of ammonia may also be seen with gastrointestinal bleeding, where the blood cells are haemolysed in the intestines, releasing protein. Please discuss this with your doctor am sure he will provide further assistance. Hope this helped and do keep us posted.

Does anyone know the name for the condition that leads to elevated ammonia levels in the blood? I think it happens when the liver is less able to remove toxins from the blood and can lead to confusion and other symptoms. Thanks for any input.

Yes it does. High levels of ammonia cause hepatic encephalopathy which in turn can cause confusion, sleepiness and forgetfulness. There are medications to help lower those levels. Speak to your hep doc.

Chemicals (one being ammonia) normally detoxified by the liver accumulate in the bloodstream because the liver is too damaged to properly clean them from the blood so these toxins go to the brain and can disrupt normal brain function causing confusion, sleep disturbances, slurred speech, drowsiness, stupor and finally coma, which can be fatal without emergency care.

He went back in the hospital yesterday for the 10th time this year, because his ammonia levels got so high that he couldn't talk, walk, swallow. We don't know what else to do to manage his condition. Any advice or similar experience would be appreciated.

An ammonia test measures the amount of ammonia in the blood. Most ammonia in the body forms when protein is broken down by bacteria in the intestines. The liver normally converts ammonia into urea, which is then eliminated in urine. Ammonia levels in the blood rise when the liver is not able to convert ammonia to urea. This may be caused by cirrhosis or severe hepatitis. Since you are on this forum I assume you have hep c? Are you experiencing the effects of toxic buildup in your blood?

sorry for the mispelling

in the scenario that you describe, the patient could definitely have understood and comprehended what was going on.

I am also wondering in advanced cirrohsis will the lactolose eventually be uneffective in bringing down the ammonia levels? My final question is what kind of life expectancy is there when the cirrohsis reaches the level that she is at?

Ammonia levels in the brain

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