Overview Ammonia Normal Value Range Pathophysiology Special considerations Too High: Causes, Symptoms, Treatments Too Low: Causes, Symptoms, Treatments Nursing Points General Normal value range 19-60...
Overview
Ammonia
Normal Value Range
Pathophysiology
Special considerations
Too High: Causes, Symptoms, Treatments
Too Low: Causes, Symptoms, Treatments
Nursing Points General
Normal value range
19-60 mcg/dL
Pathophysiology
Byproduct of protein metabolism
Proteins → ammonia
Ammonia → urea via the liver
Urea excreted to the kidneys
If ammonia is not converted to urea
Ammonia ↑ in bloodstream
Causes hepatic encephalopathy
Neurotoxic
↓ Level of consciousness
Confusion
Altered mental status
Refer to Neuro lesson 03.06 Encephalopathies
Special considerations
Sent in either green or lavender tube
Typically sent on ice
Discuss with facility lab or unit
Elevations in ammonia
Liver failure
Treatment:
Lactulose
Ammonia binding agent
Given PO or PR
Ammonia excreted via stool
Hepatic encephalopathy
TPN
GI hemorrhage
Reye’s syndrome
Decreased ammonia levels
Antibiotics
Assessment
Assess patient’s cognition and level of consciousness
Assess patient’s ability to swallow and protect airway
Therapeutic Management
Lactulose via rectal tube or PO if patient can tolerate oral medications and follow directions