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Diabetes

High ammonia level in the blood

04/11/2003

Question:

My husband has a liver disorder and diabetes. My question is what causes the ammonia level in the blood to rise drastically and how is it controlled?

Answer:

Ammonia is a byproduct of a step in protein metabolism that ordinarily takes place in the liver. When that metabolic function is working normally, the ammonia does not accumulate to any significant extent. The ammonia can however rise to a dangerous or worrisome level most commonly in people with severe liver disease or less commonly in some people with rare metabolic disorders. The ammonia becomes a marker of the severity of the impairment of the liver in a setting like your husband`s. In people with liver disease, we use a drug called lactulose during an acute situation to reduce the amount of protein breakdown in the intestine by bacteria and indirectly reduces the ammonia level. Over the longer term, the key is better liver function, whether by some healing and recovery of the liver or in extreme situations by liver transplantation. The diabetes is not a key part of the issue here.

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Response by:

Robert M Cohen, MD Robert M Cohen, MD
Professor of Clinical Medicine
College of Medicine
University of Cincinnati