Description

Overview

1. Ammonia
   1. Normal Value Range
   2. Pathophysiology
   3. Special considerations
   4. Too High: Causes, Symptoms, Treatments
   5. Too Low: Causes, Symptoms, Treatments

Nursing Points

General

1. Normal value range
   1. 19-60 mcg/dL
2. Pathophysiology
   1. Byproduct of protein metabolism
      1. Proteins → ammonia
      2. Ammonia → urea via the liver
      3. Urea excreted to the kidneys
   2. If ammonia is not converted to urea
      1. Ammonia ↑ in bloodstream
      2. Causes hepatic encephalopathy
         1. Neurotoxic
         2. ↓ Level of consciousness
         3. Confusion
         4. Altered mental status
      3. Refer to Neuro lesson 03.06 Encephalopathies
3. Special considerations
   1. Sent in either green or lavender tube
   2. Typically sent on ice
   3. Discuss with facility lab or unit
4. Elevations in ammonia
   1. Liver failure
      1. Treatment:
         1. Lactulose
            1. Ammonia binding agent
            2. Given PO or PR
            3. Ammonia excreted via stool
   2. Hepatic encephalopathy
   3. TPN
   4. GI hemorrhage
   5. Reye's syndrome
5. Decreased ammonia levels
   1. Antibiotics

Assessment

1. Assess patient's cognition and level of consciousness
2. Assess patient's ability to swallow and protect airway

Therapeutic Management

1. Lactulose via rectal tube or PO if patient can tolerate oral medications and follow directions

Nursing Concepts

1. Lab Values
2. Gastrointestinal/Liver Metabolism