Re: Elevated venous ammonia
Re: Elevated venous ammonia
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Posted by HFHSM.D.-rf on March 25, 1998 at 23:24:46:
In Reply to: Elevated venous ammonia posted by Robert A. MUller on March 15, 1998 at 09:05:18:
: Dear Doctor;
I am a 40 year old male plagued with LLQ pain and discomfort and RUQ pressure and random pain for over a year.
Have had random elevations of Bilirubin, GGT, LDH, and ammonia.
Bilirubin total:1.9 mg/DL max.
GGT: 73 U/L max.
LDH: 220 IU/L max.
Venous ammonia: 108 uMoL/L
Bun 3mg/DL min value.
Symptoms: Ribbon thin stools, random red blood on stool, random morning vomiting, no weight loss,
Other studies:
Sigmoidoscopy in 11/97 negative.
Sigmoidoscopy in 2/98 positive for diverticulosis with scaring through out the sigmoid colon.
Liver ultrasound: 1cm hemangioma near portal vein. Suboptimal scan of entire liver due to bowel gas.
CT abdoman & pelvis: negative except for scattered diverticuli on sigmoid colon and a few hernias.
My Concern: What is the significance in any of the ammonia? I am concerned that it may be having
CNS effects as I do have tremor, memory issues, problems sleeping. All started with the beginning of these GI issues.
Any Suggestions or comments?
Thanks.
Robert A. Muller
________Dear Robert A. Muller,
There are several aspects of your letter that require comment. The result of the venous ammonia test is difficult to interpret and it is uncertain whether this test has any implications for understanding the cause of your symptoms. Usually arterial ammonia is measured because the venous value will change depending on the amount of time that the tourniquet is around the arm. If we assume, however, that the venous ammonia value is meaningful, there are several conditions to consider. First one must exclude liver disease. The elevated GGT could be compatible with ongoing liver disease. The unremarkable CT of the abdomen and limited ultrasound study of the liver do not completely exclude intrinsic liver disease. You should arrange to see a hepatologist for definitive evaluation of your liver status. Other possibilities to consider to explain an elevated ammonia are deficiencies of the urea cycle ( usually presents early in life) and patients who have had their urters surgically connected to their bowel. The abdominal pains, thin stools, red blood with the stool and morning vomiting should be evaluated. The fact that you are able to maintain your weight is encouraging but does not exclude small intestine or colon diseases. With regard to your specific questions, I do not think that the ammonia is causing your tremor, memory problems etc. These symptoms. However, can be due to liver disease and therefore you should see a gastroenterologist/hepatologist..
This response is offered for your general information and should not replace the conclusions drawn from a careful and complete evaluation by a physician. W would be happy to meet you personally in order to better characterize the cause of your symptoms and to provide reassurance. If you wish to be seen at Henry Ford Health System, please call (313) 876-2393 and request consultation with Dr. Fogel, one of our experts in the diagnosis and treatment ofliver and intestinal diseases. HFHSM.D.-rf
*keywords: ammonia, hepatitis, irritable bowel disease
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