II. Labs
- Normal: 10-80 ug/dl
- Send sample on ice and run without delay
III. Causes: Increased Serum Ammonia
- Hepatic failure
- Hepatic Encephalopathy
- Cirrhosis
- Reye's Syndrome
- Portacaval shunt
-
Inborn Errors of Metabolism
- Urea Cycle Disorders
- Protein Metabolism Disorders (Organic acidemia)
- Medications
- Diuretics
- Polymixin B
- Methicillin
- Valproic Acid (Depakote)
- See Valproic Acid Toxicity (includes L-Carnitine protocol)
IV. Causes: Decreased Serum Ammonia
- Renal Failure
- Medications
- Neomycin
- Lactulose
- Tetracycline