Rising Serum Ammonia in Liver Cirrhosis

Abstract Advanced liver cirrhosis is frequently associated with fluctuations in serum ammonia, but new events can drive up the value. Pivotal in the mechanism of hepatic encephalopathy, ammonia may tip the balance between excitatory and inhibitory neurotransmitters. Failed liver clearance impairs conversion of ammonia to urea and glutamine and, consequently, creates a surfeit of glutamate. Ammonia then becomes a major toxin damaging the brain, and the damage may become irreversible. It is not so well known to us that hyperammonemia in chronic liver cirrhosis could cause havoc, resulting in ICU intensive care unit admission and prolonged mechanical ventilation. The spectrum of brain lesions in liver disease is discussed here.