Ammonia levels

[jugs0615]

My uncle has been hospitalized in the Univ. of Utah hospital for around 4 1/2 weeks now.  He was admitted with a possible MI and a Hx of Hep C.  They discovered he was septic with MRSA not a MI.  He has been on a vent for 4 weeks, several I&D's at his sources of the MRSA, he is now on dialysis, and fighting to live.  They chemically sedated him and are unable to wake him up.  His condition has been unchanged for 3 weeks.  I called and asked what his ammonia levels were last week.  The nurse gave me the run around and said they were within normal limits.  Without the limits in fornt of me I don't know what they are.  My husband went to Utah 2 days after I called, and all of a sudden they were checking ammonia levels and trating him with Lactolose, which I know is the appropriate Tx.  I know that Hep patients need to be monitored for elevated ammonia levels, so why did it take me, a CNA of 17 years, to be the one who brought this to their attention?  According to their charts they never checked the levels until after I called, this means that the nurse lied to me.  Is it just me or did I possible just help to save my uncle's life?  I am begining to think that this teaching University Hosptial is not what it is craked up to be.  Being lied to by a healthecare professional is a violation of nursing code of ethics.  I am very disappointed and I encourage all family members to be proactive in their loved ones cares, and don't be afraid to ask questions.  What else can I expect form elevated ammonia levels that have be high for this long? I know that different labs have different values, but ball park, what are normal  and what are severe levels?  Will he have possible brain damage?

[becksta29]

sorry i hav no idea on ammonia etc i am wanting to know more now. why do we get ammonia build up?does every1 with hep c hav to get tested regulary?

thx 4 info

[Bill1954]

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?

If his ammonia can be effectively managed, it is unlikely he will suffer any permanent neurological damage, assuming he can survive his current condition. Some patients can tolerate very high levels; conversely, normal concentrations of ammonia do not rule out hepatic encephalopathy.

A little more on this subject:

http://www.labtestsonline.org/understanding/analytes/ammonia/test.html

Best of luck,

Bill

[orphanedhawk]

I had problems with ammonia levels due to decompensated cirrhosis and landed up in the ER delirious before I was started on lactulose again.
For some odd reason, my liver doc, whom I respect, doesn't check for them either.I know he told me why but honestly, I don't remember.

As long as  your uncle is on lactulose he should be okay but remember its a side effect of a serious problem.

[Bill1954]

Holy cow! I just saw your profile pic… you look so much younger. Must be something with the Celcept ?

Bill :)

[orphanedhawk]

Amazing what drugs can do, huh?

Actually I'm off cellcept and the photo is  my grandtoddler Amelie.