What’s the Correlation Between Ammonia Levels in Your Blood and Cirrhosis?

Cirrhosis is a type of liver disease. It happens when liver cells become scarred over time by a wide range of causes, including autoimmune hepatitis or long-term heavy alcohol use. Scarred liver cells lose their ability to produce enzymes that use ammonia to make urea.

Urea helps your body remove waste products and toxins that your kidneys process. It leaves your body in your urine alongside the removed waste and toxins.

When ammonia passes through the liver and doesn’t react with these enzymes to make urea, ammonia can go right back into your bloodstream and build up over time.

A blood test can check for ammonia levels.

Laboratories analyze the blood sample and measure how many micrograms (mcg) of ammonia are present in every deciliter (dL) of blood, written as mcg/dL.

Typical ammonia levels with cirrhosis can range from 54–122 mcg/dL.

A 2019 study suggests that ammonia levels ranging from 124–205 mcg/dL were associated with a higher risk of death from cirrhosis.

Ammonia levels normally fluctuate throughout people’s lives. But there isn’t a widely accepted blood ammonia level that’s a reliable cutoff between “normal” and high levels. Typical ammonia levels can also vary across sexes.

Some common symptoms of high ammonia levels in people with cirrhosis include:

• feeling confused or disoriented
• feeling sleepy even when you get enough sleep
• losing consciousness or blacking out suddenly or for long periods (coma)
• abrupt mood changes
• shaky hands

Some symptoms of high ammonia levels in babies or young children include:

• irritability
• vomiting
• exhaustion
• seizures

Treatment for high ammonia levels in blood may depend on the cause.

Some common treatments include:

• Antibiotics: Antibiotics like rifaximin (Xifaxan) can treat infections that may cause liver damage.
• Osmotic laxatives: Lactulose can help change how ammonia is made in your gastrointestinal (GI) tract so it doesn’t build up as quickly.
• L-ornithine and L-aspartate (LOLA): LOLA can help liver enzymes react more readily with ammonia to make urea.
• Zinc supplements: If there is a zinc deficiency with cirrhosis, zinc supplements may help.

Here are some frequently asked questions about ammonia levels and cirrhosis.

Is ammonia high or low in cirrhosis?

Ammonia levels are high in cirrhosis.

This is because scarred liver cells can’t properly produce enzymes that normally react with ammonia to create urea and remove toxins from your body. Ammonia then passes through the liver and back into your bloodstream.

What is the typical hepatic encephalopathy ammonia level?

Typical ammonia levels in hepatic encephalopathy (HE) can vary. But ammonia levels above 141 mcg/dL are often associated with HE, especially in people with a high risk of death from liver failure.

What level of ammonia would suggest liver failure?

Ammonia levels that suggest liver failure aren’t always the same for every person.

A 2017 study found that people with ammonia levels above 165 mcg/dL had the highest risk of death from acute liver failure, with high ammonia levels resulting from alcoholic hepatitis.

How do you treat high ammonia levels in cirrhosis?

Treatments for high ammonia levels in cirrhosis include:

• reducing the amount of ammonia that’s made and absorbed by your GI tract
• helping your liver make urea by making more enzymes available to react with ammonia
• taking supplements that help your body make more substances involved in making urea, such as glutaminase

Liver damage from cirrhosis can cause ammonia to build up to high levels in your blood because damaged liver cells can’t use ammonia to make urea.

High ammonia levels in your blood can be linked to many other liver conditions, such as hepatic encephalopathy, that are more easily treated when they’re detected early.

Speak with a doctor if you have symptoms of high ammonia, such as confusion or shakiness, and consider getting your blood tested for ammonia levels.