II. Labs

  1. Normal: 10-80 ug/dl
  2. Send sample on ice and run without delay

III. Causes: Increased Serum Ammonia

  1. Hepatic failure
  2. Hepatic Encephalopathy
  3. Cirrhosis
  4. Reye's Syndrome
  5. Portacaval shunt
  6. Inborn Errors of Metabolism
    1. Urea Cycle Disorders
    2. Protein Metabolism Disorders (Organic acidemia)
  7. Medications
    1. Diuretics
    2. Polymixin B
    3. Methicillin
    4. Valproic Acid (Depakote)
      1. See Valproic Acid Toxicity (includes L-Carnitine protocol)

IV. Causes: Decreased Serum Ammonia

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