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Ammonium ion

Definition

The ammonium - blood test measures the amount of ammonia in a blood sample.

Alternative Names

Ammonia level

How the test is performed

A blood sample is needed. For information on how this is done, see: Venipuncture

How to prepare for the test

Fast for 8 - 12 hours. The health care provider may recommend that you stop taking drugs that may affect your test results.

Drugs that can falsely raise the blood amminia level include alcohol, acetazolamide, narcotics, and valproic acid. A high-protein diet can also raise the blood ammonia level. Talk to your health care provider before this test if you are taking any of these medications.

How the test will feel

When the needle is inserted to draw blood, you may feel moderate pain, or only a prick or stinging sensation. Afterward, there may be some throbbing.

Why the test is performed

This test may be done if you have or are thought to have a condition that may cause a toxic buildup of ammonia. It is most commonly used to diagnose and monitor hepatic encephalopathy, a severe liver disease.

Ammonia (NH3) is produced by cells throughout the body, especially the intestines, liver, and kidneys. Most of the ammonia produced in the body is used by the liver to produce urea. Urea is also a waste product, but it is much less toxic than ammonia.

Ammonia is especially toxic to the brain. It can cause confusion, lethargy, and sometimes coma.

Normal Values

The normal range is 15 - 45 micrograms per deciliter (mcg/dL).

Note: Normal value ranges may vary slightly among different laboratories. Talk to your doctor about the meaning of your specific test results.

What abnormal results mean

Conditions that can increase ammonia levels include:

• Congestive heart failure
• Gastrointestinal (GI) bleeding - usually in the upper GI tract
• Genetic diseases of the urea cycle
• Hyperthermia (high body temperature)
• Leukemia
• Liver failure
• Muscle exertion

What the risks are

Veins and arteries vary in size from one patient to another and from one side of the body to the other. Obtaining a blood sample from some people may be more difficult than from others.

Other risks associated with having blood drawn are slight but may include:

• Excessive bleeding
• Fainting or feeling light-headed
• Hematoma (blood accumulating under the skin)
• Infection (a slight risk any time the skin is broken)

Patients with liver disease may have clotting problems. After the venipuncture, pressure should be applied to the puncture site for several minutes to ensure that bleeding has stopped.

References

Berk PD, Korenblat KM. Approach to the patient with jaundice or abnormal liver test results. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 150.

Nevah MI, Fallon MB. Hepatic encephalopathy, hepatorenal syndrome, hepatopulmonary syndrome, and systemic complications of liver disease. In: Feldman L, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Diseases. 9th ed. Philadelphia, Pa: Saunders Elsevier;2010:chap 92.