URL of this page: https://medlineplus.gov/lab-tests/ammonia-levels/

Ammonia Levels

What is an ammonia levels test?

This test measures the level of ammonia in your blood. Ammonia, also known as NH3, is a waste product made by your body during the digestion of protein. Normally, ammonia is processed in the liver, where it is changed into another waste product called urea. Urea is passed through the body in urine.

If your body can't process or eliminate ammonia, it builds up in the bloodstream. High ammonia levels in the blood can lead to serious health problems, including brain damage, coma, and even death.

High ammonia levels in the blood are most often caused by liver disease. Other causes include kidney failure and genetic disorders.

Other names: NH3 test, blood ammonia test, serum ammonia, ammonia; plasma

What is it used for?

An ammonia levels test may be used to diagnose and/or monitor conditions that cause high ammonia levels. These include:

  • Hepatic encephalopathy, a condition that happens when the liver is too diseased or damaged to properly process ammonia. In this disorder, ammonia builds up in the blood and travels to the brain. It can cause confusion, disorientation, coma, and even death.
  • Reye syndrome, a serious and sometimes fatal condition that causes damage to the liver and brain. It mostly affects children and teenagers who are recovering from viral infections such as chicken pox or the flu and have taken aspirin to treat their illnesses. The cause of Reye syndrome is unknown. But because of the risk, children and teens should not take aspirin unless specifically recommended by your health care provider.
  • Urea cycle disorders, rare genetic defects that affect the body's ability to change ammonia into urea.

The test may also be used to monitor the effectiveness of treatment for liver disease or kidney failure.

Why do I need an ammonia levels test?

You may need this test if you have liver disease and are showing symptoms of a brain disorder. Symptoms include:

  • Confusion
  • Excessive sleepiness
  • Disorientation, the condition of being confused about time, place, and/or your surroundings
  • Mood swings
  • Hand tremors

Your child may need this test if he or she has symptoms of Reye syndrome. These include:

Your newborn baby may need this test if he or she has any of the above symptoms. The same symptoms may be a sign of a urea cycle disorder.

What happens during an ammonia levels test?

A health care professional will take a blood sample from a vein in your arm, using a small needle. After the needle is inserted, a small amount of blood will be collected into a test tube or vial. You may feel a little sting when the needle goes in or out. This usually takes less than five minutes.

To test a newborn, a health care provider will clean your baby's heel with alcohol and poke the heel with a small needle. The provider will collect a few drops of blood and put a bandage on the site.

Will I need to do anything to prepare for the test?

You should not exercise or smoke cigarettes for about eight hours before an ammonia test.

Babies do not need any special preparations before the test.

Are there any risks to the test?

There is very little risk to having a blood test. You or your child may have slight pain or bruising at the spot where the needle was put in, but most symptoms go away quickly.

What do the results mean?

If your results show high ammonia levels in the blood, it may be a sign of one of the following conditions:

In children and teens, it may be a sign of Reye syndrome.

In infants, high ammonia levels may be a sign of a genetic disease of the urea cycle or a condition called hemolytic disease of the newborn. This disorder happens when a mother develops antibodies to her baby's blood cells.

If your results were not normal, your health care provider will need to order more tests to find out the reason for your high ammonia levels. Your treatment plan will depend on your specific diagnosis.

If you have questions about your results, talk to your health care provider.

Is there anything else I need to know about an ammonia levels test?

Some health care providers think blood from an artery may provide more useful information about ammonia than blood from a vein. To get a sample of arterial blood, a provider will insert a syringe into the artery in your wrist, elbow crease, or groin area. This method of testing is not used very often.

References

  1. American Liver Foundation. [Internet]. New York: American Liver Foundation; c2017. Diagnosing Hepatic Encephalopathy; [cited 2019 Jul 17]; [about 4 screens]. Available from: https://liverfoundation.org/for-patients/about-the-liver/diseases-of-the-liver/hepatic-encephalopathy/diagnosing-hepatic-encephalopathy/#what-are-the-symptoms
  2. Hinkle J, Cheever K. Brunner & Suddarth's Handbook of Laboratory and Diagnostic Tests. 2nd Ed, Kindle. Philadelphia: Wolters Kluwer Health, Lippincott Williams & Wilkins; c2014. Ammonia, Plasma; p. 40.
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  4. Merck Manual Consumer Version [Internet]. Kenilworth (NJ): Merck & Co., Inc.; c2019. Hepatic Encephalopathy [updated 2018 May; cited 2019 Jul 10]; [about 2 screens]. Available from: https://www.merckmanuals.com/home/liver-and-gallbladder-disorders/manifestations-of-liver-disease/hepatic-encephalopathy?query=ammonia
  5. National Cancer Institute [Internet]. Bethesda (MD): U.S. Department of Health and Human Services; NCI Dictionary of Cancer Terms: disorientation; [cited 2019 Jul 17]; [about 4 screens]. Available from: https://www.cancer.gov/publications/dictionaries/cancer-terms/def/disorientation
  6. National Heart, Lung, and Blood Institute [Internet]. Bethesda (MD): U.S. Department of Health and Human Services; Blood Tests [cited 2019 Jul 10]; [about 3 screens]. Available from: https://www.nhlbi.nih.gov/health-topics/blood-tests
  7. Naylor EW. Newborn screening for urea cycle disorders. Pediatrics [Internet]. 1981 Sep [cited 2019 Jul 10]; 68(3): 453–7. Available from: https://pediatrics.aappublications.org/content/68/3/453.long
  8. NIH U.S. National Library of Medicine: Genetics Home Reference [Internet]. Bethesda (MD): U.S. Department of Health and Human Services; How is newborn screening done?; 2019 Jul 9 [cited 2019 Jul 10]; [about 3 screens]. Available from: https://ghr.nlm.nih.gov/primer/newbornscreening/nbsprocedure
  9. UF Health: University of Florida Health [Internet]. Gainesville (FL): University of Florida Health; c2019. Ammonia blood test: Overview [updated 2019 Jul 10; cited 2019 Jul 10]; [about 2 screens]. Available from: https://ufhealth.org/ammonia-blood-test
  10. University of Rochester Medical Center [Internet]. Rochester (NY): University of Rochester Medical Center; c2019. Health Encyclopedia: Ammonia [cited 2019 Jul 10]; [about 2 screens]. Available from: https://www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=167&ContentID=ammonia
  11. UW Health [Internet]. Madison (WI): University of Wisconsin Hospitals and Clinics Authority; c2019. Health Information: Ammonia: How It is Done [updated 2018 Jun 25; cited 2019 Jul 10]; [about 5 screens]. Available from: https://www.uwhealth.org/health/topic/medicaltest/ammonia/hw1768.html#hw1781
  12. UW Health [Internet]. Madison (WI): University of Wisconsin Hospitals and Clinics Authority; c2019. Health Information: Ammonia: How To Prepare [updated 2018 Jun 25; cited 2019 Jul 10]; [about 4 screens]. Available from: https://www.uwhealth.org/health/topic/medicaltest/ammonia/hw1768.html#hw1779
  13. UW Health [Internet]. Madison (WI): University of Wisconsin Hospitals and Clinics Authority; c2019. Health Information: Ammonia: Results [updated 2018 Jun 25; cited 2019 Jul 10]; [about 8 screens]. Available from: https://www.uwhealth.org/health/topic/medicaltest/ammonia/hw1768.html#hw1792
  14. UW Health [Internet]. Madison (WI): University of Wisconsin Hospitals and Clinics Authority; c2019. Health Information: Ammonia: Test Overview [updated 2018 Jun 25; cited 2019 Jul 10]; [about 2 screens]. Available from: https://www.uwhealth.org/health/topic/medicaltest/ammonia/hw1768.html#hw1771
  15. UW Health [Internet]. Madison (WI): University of Wisconsin Hospitals and Clinics Authority; c2019. Health Information: Ammonia: Why It is Done [updated 2018 Jun 25; cited 2019 Jul 10]; [about 3 screens]. Available from: https://www.uwhealth.org/health/topic/medicaltest/ammonia/hw1768.html#hw1774

The medical information provided is for informational purposes only, and is not to be used as a substitute for professional medical advice, diagnosis or treatment. Please contact your health care provider with questions you may have regarding medical conditions or the interpretation of test results.

In the event of a medical emergency, call 911 immediately.