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1008841 tn?1293602560

Ammonia

Hi, it's been quite a while since I posted anything. I went to Duke they said that I don't qualify for a transplant because I have a history of severe deppression. But, they said that I'm not bad enough yet to even worry about it. I don't know how she even knew that since I hadn't seen her in about three years. Theyu did a CT scan, but they said this before they had done any test.
What test do they do to test for to test for ammonia. I was just looking through  the test that they have given me and I can't find one that says anything about ammonia. They do give me lactolose to try to prevent that, but I just wondered what the test is called. My albumin was a little low so was my sodium, and calcium, on my last test.
They do give me propranolol, now, for my varices. They also give a bunch of dieritics. We'll 40mg furosemide and 100mg spironolacton. They use to give me 80mg of furosemide. I have cramps all the time in my feet and legs. and heart palapatations.
Well, mostly I was wondering about the ammonia, because my sisters xhusband just went to the hospital with that. He has cirrhosis, also.
8 Responses
Avatar universal
its a blood test for ammonia - while encephalopathy usually indicates cirrhosis it can occur previously - i went to a transplant center and they said nothing about depression -i have been on anti ds for years - just quit smoking and loose weight they told me
446474 tn?1446351282

What is your MELD score from your last blood test?
Are you compensated or decompensated? If you are compensated, have you talked to your doc about hepatitis C treatment?
Cramps in the legs and feet are very common with cirrhosis. You might want to try "Leg Cramps" you can find it at any Walgreens. It seems to work for me.
You should ask the hepatologist for Xifaxan. For many people it is more effective in stopping HE flare-ups and has no nasty side-effects like Lactulose.
Too high of dosage of diuretics can cause heart palpitations. The dose you are on is the standard dose. Do you have ascites? Swollen feet or ankles?

A history of depression is not the issue. If you can show that your depression is managed they can not deny you a chance to be listed. The only way they can deny you is if they believe that you are too mentally unfit your donated liver for the rest of your life. There is a huge shortage of organs in this country. Since demands for donated livers is so high they are obligated only to list patients for liver transplant that they believe will take care of the donated precious liver. It is a commitment we all make before being listed. Remember, a person has died to donate their liver. There are not enough livers for everyone who needs one. If a patient is the recipient of a donated liver someone else who is also waiting may die waiting. So they want to give it to the patient with the best chance of living.
If you can make a good effort/prove your can handle the operation and life taking care of a donated liver you will be listed. Maybe have your own psychiatrist write the transplant center a letter saying you are under their care and are managing your depression. Or you could go to another transplant center and have your psychiatrist write a letter when you go to see the center's psychiatrist. Don't give up. It can be done. Just as alcoholics can get transplants as long as they can show that they never will drink again.

"What test do they do to test for to test for ammonia"?
It is an ammonia blood test. It is listed as “Ammonia” on all the blood test results I've seen. It is separate from other tests and using one tube of blood.
You say you are wondering about ammonia? Here is a brief overview....

Hepatic Encephalopathy (mental changes, coordination changes, sleeping changes) that can lead to coma.

Encephalopathy can be caused by many things: a build-up of toxins (especially ammonia), drugs, alcohol, electrolyte disturbances, infections, internal bleeding, excess protein in the diet (especially red meat), constipation, dehydration, etc.

Your sister's ex-husband was probably extremely confused or in a coma if he is hospitalized. These are the extreme complications of encephalopathy. Luckily they are temporary. So I am guessing you are wondering whether encephalopathy is an issue for you.

Mental Signs of HE:

*Forgetfulness, mild confusion
*Poor judgment
*Being extra nervous or excited
*Not knowing where they are or where they're going
*Inappropriate behavior or severe personality changes

Physical Signs of HE:

*Breath with a musty or
*sweet odor
*Change in sleep patterns
*Worsening of handwriting or loss of other small hand movements
*Movements or shaking of hands or arms
*Slurred speech
*Slowed or sluggish movement

Minimal HE (MHE) is the first stage of the disease. It often goes undetected. There is some memory loss, less coordination and insomnia.

Grade 1: Patients appear slightly unaware. They may seem extremely excited or anxious. They have a shortened attention span.

Grade 2: Patients are very tired and may seem indifferent. They keep forgetting where they are and are confused about time. Their personality might change, and they may behave inappropriately.

Grade 3: Patients are extremely sleepy but respond when spoken to. They are confused and severely disoriented.

Grade 4: Coma—the patient is unconscious or unresponsive.

So to prevent HE you should not eat red meats. They are harder to digest and their produce more ammonia.

Hope this helps a little.
Hector
Avatar universal
Hi there.  The blood test for ammonia is AFP or alpha fet protein test.  It measures the level of ammonia in your blood.  When it is high it is not much fun.  The explaination in Hector SF's post is so accurate.  The first indication for me that it is high is that my hands shake and I can't write and it's hard to hold fork or spoon.  I also get confused easily and can't sort things out.  Sometimes I think I'm okay - until I get it in control again and look back.  Lactulose has been part of my regime for quite awhile and I know when I need to up the dose.  Right now you are taking the same amount of diuretics I am although it sometimes changes depending on my fluid.  The cramps are horrendous, especially if I'm on my feet too much or even try to shop at the grocery store.  I have found only one thing that works almost immediately for the cramps and it might seem a little silly but I have used it exclusively for the last 1 1/2 years.  I fiund it once at a health food store but otherwise I order it online.  It's a liquid you drink and comes in an 8 ounce bottle.  The bottle says" Proven old Amish Formula" "Stops leg and foot cramps in about 1 minute'
Google just - Stops leg and and foot cramps.  It is a mixture of organic apple cider vinegar, natural ginger and garlic juice.  I slug about 2  tablespoons.  It's strong, but believe me, when you are cramping you will do anything and it always works.  Sometimes I go through a bout of cramps - one every 30 minute through the middle of the night and this keeps me from screaming.  So, just a thought if nothing else takes the cramps away quickly.

There are a lot of testings to go through before they approve you for a transplant.  When my AFP shot up to 2100 my gastro sent me immediately to Hershey Med to start the evaluation.  I've been through every imaginable test for the last 5 months.  Shrinking the tumor on my liver was not something I want to repeat.  Because of having HCC and they don't want it to start growing again my transplant co-ordinator said I'm about 9 months til a new liver.  My meld score is in the high 20's and it needs to be in the 30's and it goes up 2 points every 3 months because of the tumer.

I've been sick for a long time with various things and I am so ready for a transplant, and even that has a long recouperation.  But I spend most of my time at home, sleeping or behind the computer because I get too wiped out.  Every now and then I pretend to have a normal day.  Tonight my husband and I are going out for dinner, which can be hard trying to keep the sodium in range.  I've told you more than you probably wanted but I wanted you to have a little backround.  There are a lot of us out there and it requires a lot of patience and education.
Avatar universal
i believe the afp test is a tumor marker not ammonia level test - i wish you well - im being evaluated at upmc pittsburg transplant clinic
Avatar universal
Your correct it is a tumor marker......
1008841 tn?1293602560
I thank you all for your answers to my my questions. Sorry, it took me to get back to you. Duke puts all my test and CT scans, other things on line for me to look at. So I went to look if they said anything about ammonia or my MELD score. I got to reading all the stuff. My last CT looked really bad, especially around my spleen. So I was looking back on my other CT scans. It was storming outside. All of the sudden the power went out. It wasn't out long but, I could never get that computer going again. I finally got one of My brothers going. So now I'm back. But, anyway Hector They never said any thing about a meld score, or an ammonia test. It's weird, I think since my regular Doctor sent me there to evaluated for a liver transplant, after she had sent me for a endoscopy at the hospital here, and Gasto DR. who did it said I needed to get a liver transplant not more treatment. Which is what Duke wants me to do.
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