Unraveling the Mystery: Ammonia Testing in Hepatic Encephalopathy

Ammonia is central to the pathophysiology of hepatic encephalopathy (HE). Elevated serum ammonia levels are associated with death and transplantation.

Normal ammonia levels are less common in West-Haven Grade 3 HE and are rare in Grade IV. There is a possible utility for therapeutic targets to guide therapy.

Serum ammonia testing exhibits substantial laboratory variability and lability. There is no standardized upper limit of normal for ammonia levels.

Ammonia levels show high variability across the severity spectrum of HE. Normal ammonia levels can occur, particularly in West-Haven Grade 1-3 HE.

Ammonia levels are affected by diet, exercise, renal function and gastrointestinal (GI) bleeding

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