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high ammonia levels
hello,
had my tests and blood works done today. USG says mild hepatomegaly. All other blood numbers, lft etc are normal. I had gone to the tests fasting and without gooing to the morning loo (very difficult) under the impression that stool sample may be required. They did not do that test.
Subsequently, i had lunch, and smoked. And then had the blood ammonia test. It came high at 139 ( normal: upto 40)
i do get forgetful and feel funny at times, had mild vertigo.

My question is not using the loo (full bowels!) and luch and smoke, can they alter ammonia readings?

If not, then at 139, it cld be encephalopathy. But my GP had ruled out additional testing for liver as he felt not one clinical finding pointed to something seriously wrong. (i have  not shared the ammonia level with him)
should i retest tommorow with no smoke and fasting, or should i wait a few days and then retest?

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I found the following after a quick search.

"# Increased levels of ammonia may also be seen with: Gastrointestinal bleeding - blood cells are hemolyzed in the intestines, releasing protein.
# Muscular exertion - muscles produce ammonia when active and absorb it when resting.
# Tourniquet use - ammonia levels can be increased in the blood sample collected.
# Drugs that can increase ammonia include: alcohol, barbiturates, diuretics, valproic acid, and narcotics.
# Smoking"

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

What Affects the Test

"Reasons you may not be able to have the test or why the results may not be helpful include:

    * Smoking.
    * Severe constipation.
    * Eating a high-protein or a low-protein diet.
    * Using medicines that increase blood ammonia levels, such as some diuretics (such as furosemide), acetazolamide, and valproate.
    * Using medicines that decrease ammonia levels, such as neomycin, tetracycline, diphenhydramine, isocarboxazid, phenelzine, and tranylcypromine, and lactulose.
    * Strenuous exercise just before the test."

See: http://www.webmd.com/digestive-disorders/ammonia?page=3

It appears that smoking and perhaps not going to the bathroom may have contributed to your elevated ammonia level. I have no idea as to what extent these factors may have influenced your ammonia level.

While elevated ammonia levels are seen in cirrhotic patients there can be encephalopathy with normal ammonia levels and there can also be no mental impairment in some patients with elevated ammonia levels. Basically, ammonia levels are of limited use for diagnosing cirrhosis or hepatic impairment. I would also think some other results of your blood work would have been out of range if you are cirrhotic or are suffering significant liver impairment. I haven't seen vertigo cited as a symptom of encephalopathy but it may be. I think you would be experiencing more mental issues that just a little forgetfulness which I think we all have to one degree or another.

I believe that renal system (kidney) dysfunction can also be associated with elevated ammonia levels. If this were the case I would expect that your BUN(urea nitrogen) and/or creatinine blood levels would be out of range. If those levels are within normal range renal dysfunction seems unlikely.

My advice is to speak with your doctor about your ammonia level and see what he/she thinks might be causing it. Ask about further testing. I would probably wait a few days to test if your doctor is OK with that.

Good luck,
Mike
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I just read your other thread in which you mention increasing INR and significant alcohol use. That changes the picture somewhat and suggests that the liver may be involved.
See a liver specialist and get some answers.

Mike
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Thanks mike,

yes you are right. These are the only two things that have come out as out of range in the entire blood work. Kindney functions are right, liver functions are right, heart function tests are right etc. Inr is elevated but in docs opinion , only mildly elevated and clinically insignificant.

Somewhere on this site i had read that
1. Cirrhosis will cause scarring, portal hypertension.
2. Portal hypertension will cause  increased size of spleen.

Since my spleen size is ok, portal vein is ok as per usg, can these inr and ammonia values alone merit a ct scan? Is spleen size not relevant in cirrhosis?
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