From the Guidelines
An ammonia level of 79 is considered elevated and requires prompt medical attention to prevent neurological impairment and cerebral edema. According to the consensus guidelines for management of hyperammonaemia in paediatric patients receiving continuous kidney replacement therapy 1, treatment should focus on lowering ammonia levels through medications and dietary changes. Patients should be started on a low-protein diet (0.6-0.8 g/kg/day) to reduce ammonia production, and intravenous fluids may be needed to correct dehydration.
Some key points to consider in the management of hyperammonaemia include:
- Discontinuing all oral feeds and providing adequate calories as intravenous glucose and lipids 1
- Using nitrogen-scavenging agents such as sodium benzoate and sodium phenylacetate at the recommended dosage 1
- Considering hemodialysis or continuous kidney replacement therapy (CKRT) for severe elevations or rapid rise in blood ammonia levels 1
- Monitoring ammonia levels regularly to assess treatment effectiveness
It is essential to note that the clinical features of hyperammonaemia can vary depending on the age of the patient and the cause of the elevation in plasma ammonia levels 1. Symptoms may include lethargy, loss of appetite, vomiting, and in severe cases, seizures, coma, or death. Regular monitoring of ammonia levels and prompt treatment are crucial to prevent long-term neurological damage and improve outcomes. Patients should avoid medications that can worsen liver function, such as acetaminophen in high doses, and alcohol should be strictly avoided.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Ammonia Level of 79
- The provided ammonia level of 79 is significantly higher than the normal concentration of approximately 30 µM, as mentioned in the study 2.
- Hyperammonemia, a condition characterized by elevated ammonia levels, can lead to serious neuropsychiatric complications, including hepatic encephalopathy (HE) 3, 4.
- The treatment of hyperammonemia typically targets the reduction of ammonia production and absorption, as well as the enhancement of ammonia removal 3, 5.
- Lactulose and rifaximin are commonly used treatments for hyperammonemia, particularly in the context of hepatic encephalopathy, as they help to decrease ammonia production and absorption in the gastrointestinal tract 3, 6, 2.
- In some cases, mild hyperammonemia may resolve with fluid bolus and maintenance fluid, without the need for lactulose or rifaximin, as seen in a case study 6.
- The management of hyperammonemia requires a solid understanding of the underlying pathophysiology, differential diagnosis, and treatment approaches available 4.