Ammonia, derived from the catabolism of amino acids and from the action of intestinal bacteria on dietary protein, is converted to urea in the liver hepatocytes and so rendered nontoxic. Under normal circumstances the concentration of ammonia in the circulation remains low, typically less than 50 μmol/L (85 μg/dL). Studies have shown that excess ammonia can have a toxic effect on the central nervous system and clinical manifestations are typically neurological disturbances.
Elevated levels of ammonia may be either due to: (i) Inborn errors of metabolism; or (ii) Secondary to other conditions. Inborn errors of metabolism are the major cause of elevated ammonia in infants and usually the result of urea cycle enzyme deficiencies. Inherited disorders affecting the metabolism of the dibasic amino acids (lysine and ornithine) and those involving the metabolism of organic acids may also produce elevated levels of circulating ammonia. Elevated ammonia may also be observed in severe liver failure as may occur in Reye’s Syndrome, viral hepatitis or cirrhosis.
| Ammonia (NH3) | 6 - 47 μmol/L | 10 - 80 μg/dL |