Changes In Blood Ammonia Research Articles

Repeated Measures of Blood and Breath Ammonia in Response to Control, Moderate and High Protein Dose in Healthy Men

Ammonia physiology is important to numerous disease states including urea cycle disorders and hepatic encephalopathy. However, many unknowns persist regarding the ammonia response to common and potentially significant physiologic influences, such as food. Our aim was to evaluate the dynamic range of ammonia in response to an oral protein challenge in healthy participants. We measured blood and breath ammonia at baseline and every hour for 5.5 hours. Healthy men (N = 22, aged 18 to 24 years) consumed a 60 g protein shake (high dose); a subset of 10 consumed a 30 g protein shake (moderate dose) and 12 consumed an electrolyte drink containing 0 g protein (control). Change in blood ammonia over time varied by dose (p = 0.001). Difference in blood ammonia was significant for control versus high (p = 0.0004) and moderate versus high (p = 0.03). Change in breath ammonia over time varied by dose (p < 0.0001). Difference in breath ammonia was significant for control versus moderate (p = 0.03) and control versus high (p = 0.0003). Changes in blood and breath ammonia were detectable by fast, minimally-invasive (blood) or non-invasive (breath) point-of-care ammonia measurement methods. These pilot data may contribute to understanding normal ammonia metabolism. Novel measurement methods may aid research into genetic and metabolic ammonia disorders.

Effects of end-stage renal disease and dialysis modalities on blood ammonia level.

Uremia results in a characteristic breath odor (uremic fetor) which is largely due to its high ammonia content. Earlier studies have shown a strong correlation between breath ammonia and blood urea levels and a 10-fold reduction in breath ammonia after hemodialysis in patients with chronic kidney disease. Potential sources of breath ammonia include: (i) local ammonia production from hydrolysis of urea in the oropharyngeal and respiratory tracts by bacterial flora, and (ii) release of circulating blood ammonia by the lungs. While the effects of uremia and hemodialysis on breath ammonia are well known their effects on blood ammonia are unknown and were explored here. Blood samples were obtained from 23 hemodialysis patients (immediately before and after dialysis), 14 peritoneal dialysis patients, and 10 healthy controls. Blood levels of ammonia, creatinine, urea, and electrolytes were measured. No significant difference was found in baseline blood ammonia between hemodialysis, peritoneal dialysis and control groups. Hemodialysis procedure led to a significant reduction in urea concentration (P < 0.001) which was paradoxically accompanied by a modest but significant (P < 0.05) rise in blood ammonia level in 10 of the 23 patients studied. Change in blood ammonia pre- and post-hemodialysis correlated with change in serum bicarbonate levels (r = 0.61, P < 0.01). On subgroup analysis of patients who had a rise in blood ammonia levels after dialysis, there was a strong correlation with drop in mean arterial pressure (r = 0.88, P < 0.01). The nadir intradialytic systolic blood pressure trended lower in the hemodialysis patients who had a rise in blood ammonia compared to the patients who manifested a fall in blood ammonia (124 ± 8 vs. 136 ± 6 mmHg respectively, P = 0.27). Fall in blood urea following hemodialysis in ESRD patients was paradoxically accompanied by a modest rise in blood ammonia levels in 43% of the patients studied, contrasting prior reported effects of hemodialysis on breath ammonia. In this subgroup of patients, changes in blood ammonia during hemodialysis correlated with rise in blood bicarbonate and fall in mean arterial blood pressure.

The effect of aronia, montmorency, and Prunus mume supplementation on blood fatigue factors and muscle damage enzymes after running 10 km

The purpose of this study was to analyze the effects of intake of aronia, montmorency, and Prunus mume on 10 km endurance exercise by investigating changes in blood lactate, ammonia, creatine kinase (CK), and lactate dehydrogenase (LDH), and eventually to recommend them as ergogenic aids, which are effective for recovering from exercise fatigue and muscle damage. The subjects were divided into a P. mume intake group, an aronia intake group, a montmorency intake group, and a control group. Blood samples were taken from the brachial vein at rest, and at 0, 30 min, and 24 hr after running to measure recovery status. All data were analyzed by a two-way repeated-measures analysis of variance using SPSS. The results are summarized as follows: The changes in blood ammonia and LDH concentration following 10 km of running were not significantly different among the groups. However, lactate and CK recovery ratio increased significantly in the aronia and montmorency groups compared to those in the P. mume and control groups. In particular, CK concentration was significantly different in the montmorency group compared to that in the other groups. These results suggest that the effects of aronia and montmorency are associated with improved recovery from muscle fatigue and damage induced by highly intensive exercise, endurance exercise, or overtraining. In particular, montmorency is recommended as an ergogenic aid to inhibit muscle pain resulting from high-intensity endurance exercise.

Hepatic and metabolic changes in surgical colic patients: a pilot study

To determine: (1) changes in blood ammonia, bile acid (BA), bilirubin, triglyceride, and glucose concentrations and liver enzyme activities in perioperative colic patients and (2) the association between these laboratory findings and short-term survival. Prospective observational clinical study. Thirty-two adult horses undergoing exploratory celiotomy for colic. None. Blood samples were collected preoperatively and at 24-36 and 72-84 hours postoperatively and analyzed for blood ammonia, BA, bilirubin, triglyceride, and glucose concentrations and sorbitol dehydrogenase (SDH) and gamma glutamyl transferase (GGT) activities. Short-term survival was defined as survival to hospital discharge. Data were analyzed using a Fisher's exact test and analysis of variance. Mildly increased blood ammonia concentrations were present in 2 horses at admission. Postoperative blood ammonia concentrations were within reference intervals in all horses. There were increases in liver enzyme activities as well as in BA, triglyceride, and total bilirubin concentrations. Horses with markedly increased admission BA concentrations and SDH activities did not survive. BA concentrations and SDH activities decreased postoperatively. There was no association between GGT activity and survival; GGT activity remained increased postoperatively. Blood triglyceride concentration was increased in almost all horses postoperatively; horses that did not survive had higher triglyceride concentrations at 24-36 hours postoperatively than horses that survived. Alterations in metabolism and hepatobiliary function are common in colic patients. The results of this study provide further prognostic indices for colic patients and highlight areas for improvement in patient management.

Amino Acid Challenge in Patients with Cirrhosis and Control Subjects: Ammonia, Plasma Amino Acid and EEG Changes

The pathogenesis of hepatic encephalopathy (HE) is controversial. We have therefore studied the effect of induced hyperammonaemia in man. 108 g of an amino acid mixture was given orally to 18 cirrhotics and 11 control subjects and changes in blood ammonia, EEG and plasma amino acids were observed. Basal (39+/-6 versus 14+/-2 micromol/l) and 120-min post amino acid (77+/-10 versus 27+/-4) blood ammonia concentrations in cirrhotics were significantly increased compared to healthy controls (p < 0.001). Associated with these changes there was a significant increase in the ratio of slow-to-fast wave activity indicating EEG slowing (+0.41+/-0.16; N=13 versus -0.05+/-0.08; N=8; p=0.036). As expected in cirrhotics, basal valine and leucine concentrations were decreased while phenylalanine, tyrosine and methionine were significantly increased. Although the basal molar ratio of branched chain amino acids to the aromatic amino acids phenylalanine and tyrosine was significantly decreased in cirrhotics (1.5+/-0.2 versus 3.2+/-0.2; p < 0.0001), after the challenge when EEG changes were apparent in cirrhotics, the ratio significantly increased (p < 0.005) in both groups to 2.7+/-0.3 versus 4.1+/-0.3 (p=0.002). In the combined groups, there were significant correlations between EEG ratio change and the 120-min blood ammonia concentration (r=0.498; p=0.022). The alterations in plasma amino acid patterns do not support a specific role for any of the amino acid groups in the pathogenesis of hepatic encephalopathy. They are however more in keeping with the direct or indirect role of ammonia.

Oral glutamine challenge in cirrhotics pre- and post-liver transplantation: a psychometric and analyzed EEG study.

Latent or sub-clinical hepatic encephalopathy is a recognized complication of cirrhosis and is thought to represent one end of the spectrum of neuropsychiatric impairment, which occurrs as a result of portal-systemic shunting. We studied the psychometric, analyzed electroencephalography (EEG), and venous blood ammonia responses to an oral glutamine challenge in 17 patients with cirrhosis and in 4 normal controls. The cirrhotics were attending for liver transplant assessment and had no clinical evidence of hepatic encephalopathy. The oral glutamine challenge was repeated following liver transplantation. Five of sixteen patients (31%) showed impaired performance on at least one of the baseline psychometric tests. There was a correlation between fasting venous ammonia and choice reaction time (r = .7, P < .01). Following glutamine challenge there was a significant increase in blood ammonia from a mean fasting value ranging between 58 micromol/L to 120 micromol/L (P < .01), between significant prolongation of reaction times of 387 ms to 428 ms (P < .01), and an increase in mean EEG amplitude between 68.5 microV to 78.6 microV (P < .001). Four normal controls who were challenged with glutamine and 6 cirrhotic patients who were challenged with water showed no change in any of these parameters. Following orthotopic liver transplantation (OLT) the eight patients studied had normal baseline psychomotor performance with significant improvements in digit symbol, digit span, information processing, number connection tests (P < .05), and reaction time (P < .005). Posttransplantation, there were no significant changes in blood ammonia, analyzed EEG, or choice reaction time in response to oral glutamine challenge (six patients). We conclude that short lived changes in blood ammonia (in cirrhotics) can cause significant impairment of sensitive tests of brain function and that psychometric performance is improved following OLT.

Oral glutamine challenge in cirrhotics pre- and post-liver transplantation: A psychometric and analyzed EEG study

Latent or sub-clinical hepatic encephalopathy is a recognized complication of cirrhosis and is thought to represent one end of the spectrum of neuropsychiatric impairment, which occurrs as a result of portal-systemic shunting. We studied the psychometric, analyzed electroencephalography (EEG), and venous blood ammonia responses to an oral glutamine challenge in 17 patients with cirrhosis and in 4 normal controls. The cirrhotics were attending for liver transplant assessment and had no clinical evidence of hepatic encephalopathy. The oral glutamine challenge was repeated following liver transplantation. Five of sixteen patients (31%) showed impaired performance on at least one of the baseline psychometric tests. There was a correlation between fasting venous ammonia and choice reaction time (r = .7, P < .01). Following glutamine challenge there was a significant increase in blood ammonia from a mean fasting value ranging between 58 micromol/L to 120 micromol/L (P < .01), between significant prolongation of reaction times of 387 ms to 428 ms (P < .01), and an increase in mean EEG amplitude between 68.5 microV to 78.6 microV (P < .001). Four normal controls who were challenged with glutamine and 6 cirrhotic patients who were challenged with water showed no change in any of these parameters. Following orthotopic liver transplantation (OLT) the eight patients studied had normal baseline psychomotor performance with significant improvements in digit symbol, digit span, information processing, number connection tests (P < .05), and reaction time (P < .005). Posttransplantation, there were no significant changes in blood ammonia, analyzed EEG, or choice reaction time in response to oral glutamine challenge (six patients). We conclude that short lived changes in blood ammonia (in cirrhotics) can cause significant impairment of sensitive tests of brain function and that psychometric performance is improved following OLT. (Hepatology 1997 Oct;26(4):870-6)

Changes in blood ammonia induced by a maximum effort in trained and untrained subjects.

Twelve healthy male volunteers, either trained or untrained, performed a maximal exercise on a cycloergometer. Venous blood samples were taken for analysis during the effort and the following recovery. Blood concentrations of lactate and ammonia, and plasmatic concentrations of alanine, glutamate and glutamine were measured. At the beginning on the effort, ammonia decreased by 32% (P < 0.01) in comparison with its mean level at rest; at 77% and 78% of maximum load there was a steeper ascent of blood ammonia and lactate vs load curve. There was a high correlation (P < 0.001) between ammonia and lactate during exercise. At the end of the effort, these two variables had significantly increased in comparison with their values at rest (P < 0.01 for ammonia and P < 0.001 for lactate), but they did not correlate with VO2max. The negative correlation existing between ammonia and VO2max at the beginning of the recovery period may imply that muscle NH3 release is inversely proportional to the subject's sports training level, this relation being less evident when blood lactate vs VO2max correlation was considered. Increase in blood glutamate level was greater in trained subjects (P < 0.05). This finding suggests that ammonia elimination is favoured by physical training. In conclusion, ammonia measurements during exercise provide a valuable information about muscle cell oxidative capacity.

1260 ALANINE-INDUCED HYPERAMMONEMIA IN HYPERLYSINEMIA AND IN SACCHAROPINURIA

It has been suggested that lysine inhibits urea cycle function both in vivo and in vitro mainly by decreasing arginase activity. We gave an L-alanine load to a patient with hyperlysinemia (fasting plasma lysine 860 μM on a 1.5 g protein/kg diet) at age 5 and 10 years, and to a patient with saccharopinuria (and hyperlysinemia) at age 3, 12.5 and 16 years. The alanine was given as a 5% aqueous i.v. infusion (6.6 mmol/kg) over 90 min and changes in blood ammonia, serum urea urinary orotic acid were measured. In healthy subjects, serum urea increases rapidly, but blood ammonia and urinary orotic acid remain unchanged after such a load. The patient with hyperlysinemia developed hyperammonemia (peak values 760 and 210 μM at 5 and 10 years of age), and orotic aciduria increased 10-fold in the first 6-h collection. Serum urea increased slowly. The saccharopinuric patient's peak ammonias were 60, 280 and 410 μM at 3, 12.5 and 16 years of age, respectively; serum urea increased always slowly. Orotic acid excretion in the latest test increased 320-fold. Addition of 1.1 mmol/kg of l-ornithine to the alanine loads abolished the hyperammonemic response totally in both, and urinary orotic acid increased only 2-3 fold. The findings suggest that patients with constant hyperlysinemia or with saccharopinuria have decreased nitrogen tolerance and may benefit from ornithine supplementation.

Changes in blood ammonia, lactate and amino acids in relation to workload during bicycle ergometer exercise in man.

Whole body exercise at intensities up top 50% VO2max has no effect on the concentration of blood ammonia but a threefold rise in blood ammonia is observed at workloads up to maximal. There is a linear relationship between blood ammonia and lactate production during exercise which suggests that the two processes may be linked to a common process of short-term energy provision. Blood glutamine and blood alanine both show rises linearly related to power output during exercise, suggesting that if these amino acids are sinks for ammonia then the process of ammonia incorporation is saturated at high workloads.

Inorganic ions and pH in the body fluids of Amazon animals

In all but 3 of 16 species of Amazon crustaceans and fishes, the activities of inorganic ions in the blood are 15–27% lower than expected. In most of the fishes, blood pH is higher than expected. In two of the fishes both departures are reversed by adding NaCl or KCl, but not H+, to the medium. Ammonia excretion varies inversely with blood and water salinity, and changes in blood ammonia induced by experimental exposure to air or high salinity can explain the changes in blood pH. Preliminary data suggest that the (Na+ + K+)-ATPase prepared from the gill of one teleost has a higher affinity for NH4+ than K+. It is suggested that at least some of the Na+ absorbed from the medium is exchanged for NH4+, and that binding to the ammonia molecule is responsible for at least some of the reduction of H+ activity in the blood.