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Ammonia Levels Test

NH3 Test

The ammonia levels test is widespread to diagnose and monitor some health issues. How NH3 Test is done, and what do the results mean?

Ammonia levels in the blood may be elevated due to kidney disease, diabetes mellitus, or liver cirrhosis. Your doctor could ask you to do the Ammonia levels test to diagnose or monitor these or other health issues.


What is an ammonia levels test?

The amount of ammonia in your blood is determined by this test. Ammonia, also known as NH3, is a waste product produced primarily in the intestines by bacteria during protein digestion.
Ammonia is generally carried in the blood to the liver, where it is transformed into two substances known as urea and glutamine. The urea is then moved to the kidneys, excreted in the urine. If the “urea cycle” does not complete the breakdown of ammonia, ammonia builds up in the blood and can enter the brain.
The brain is harmed by ammonia. Ammonia and other compounds processed by the liver can accumulate in the brain and cause hepatic encephalopathy when liver function is significantly reduced due to disorders such as cirrhosis or hepatitis.
Hepatic encephalopathy causes mental and neurological changes resulting in confusion, disorientation, sleepiness, coma, and death.

Children and infants with elevated ammonia concentrations could throw up frequently, become easily irritated and sleepy. If left untreated, they may have seizures, difficulty breathing, and fall into a coma.

The test is also known as the NH3 test, blood ammonia test, serum ammonia, and plasma.


What is the ammonia serum test used for?

NH3 Test
NH3 Test

A blood ammonia test helps your doctor to diagnose and/or monitor ammonia processing issues that can arise as a result of conditions such as:

  • Severe liver disease damage reduces the liver’s ability to process ammonia; surges in ammonia blood levels can develop in individuals with stable liver disease, especially after a triggering event such as electrolyte imbalance or gastrointestinal bleeding.
  • Reduced blood flow to the liver – Ammonia has a more challenging time getting to the liver to be processed.
  • Reye syndrome is a rare condition that affects the blood, brain, and liver, causing ammonia levels and a decrease in glucose. It primarily affects children and young adults. Most of the time, it appears to be caused by a viral infection, such as the flu or chickenpox. Children who receive aspirin are at a higher risk.
  • Kidney (renal) failure occurs when the kidneys cannot effectively rid the body of urea, resulting in an ammonia buildup in the blood.
  • A defect in the urea cycle – a deficiency in one of the enzymes required to complete the conversion of ammonia to urea – is a rare genetic disorder.
NH3 test can also be done to determine the effectiveness of treatment for kidney failure or liver disease.

When is NH3 Test ordered?

An ammonia test may be ordered when you experience the following signs and symptoms of an elevated ammonia level.
  • Changes in mental state, disorientation (the condition of being confused about time, place, and/or your surroundings).
  • Mood swings.
  • Sleepiness.
  • Hand Tumors.
  • Change in consciousness.
  • Coma.
The symptoms listed above can occur with or without liver disease or kidney failure. If you have stable liver disease, a blood ammonia test and other liver function measurements may be ordered if you become ill.
An ammonia test may be ordered when a newborn exhibits the following signs and symptoms in the first few days after birth.
  • Irritability.
  • Vomiting.
  • Sleepiness
  • Lethargy.
  • Seizures.
An ammonia test may be performed to rule out Reye syndrome when a child develops these symptoms while recovering from a viral illness, such as influenza or chickenpox. The above symptoms also may be a sign of a urea cycle disorder.

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What happens during an ammonia blood test?

Serum Ammonia Test
Serum ammonia test
  1. In a laboratory, a small needle will be used by a health care professional to draw blood from a vein in your arm.
  2. Following the insertion of the needle, a small amount of blood will be collected in a test tube or vial. A slight sting may be felt when the needle is inserted or removed.
  3. This often takes under five minutes.
To test your baby, a health care provider in a lab or clinic will clean his or her heel with alcohol and poke it with a small needle. The doctor will take a few drops of blood, and a bandage will be applied to the wound.

What are the preparations for the ammonia serum test?

  • You should avoid exercise and smoke for at least eight hours before a blood ammonia test.
  • Babies do not require any special preparations for the exam.

Is there any danger in the NH3 Test?

Having a blood test poses minimal risk. You or your child may experience minor pain or bruising where the needle was inserted, but most symptoms will subside quickly.
A blood sample taken from an artery poses little risk of complications. Don’t Lift or carry objects for at least 24 hours after having blood drawn from an artery for the ammonia test.

What is the significance of the ammonia test results?

Blood Ammonia Test
ammonia levels range, ammonia test results

Normal Ammonia levels range

Average blood ammonia level could indicate that your symptoms are caused by something other than excess ammonia. On the other hand, normal ammonia ranges do not rule out hepatic encephalopathy. Other breakdown products may also affect your mental function and consciousness, and the ammonia level in the brain can be significantly higher than in the blood. This can make it challenging to link symptoms to ammonia blood levels.

Ammonia levels reference range

Adults10-80 mcg/dL (6-47 µmol/L)
Neonates, 0 to 10 days (enzymatic)170-341 mcg/dL (100-200 µmol/L)* (PDR).  90-150 mcg/dL
Infants and toddlers from 10 days to 2 years (enzymatic)68-136 mcg/dL  or (40-8- micromole/L)
Children more than 2 years (enzymatic)19-60 mcg/dL or (11-35 µmol/L)

Hight Ammonia level

A significantly high blood ammonia level means that your body is not successfully processing and eliminating ammonia, which could be the source of your symptoms.
An elevated ammonia level in children and adults may indicate that severe liver or kidney damage has hampered the body’s ability to clear ammonia and that the brain may be affected.
High levels in infants may indicate urea cycle impairment due to a rare genetic disorder, such as a deficiency of one of the urea cycle enzymes, or associated with newborn hemolytic disease. Moderate, transient ammonia elevations are pretty standard in newborns, where the level can increase and decrease without causing noticeable signs.
High ranges of glucose and ammonia, in addition to high levels of some liver enzymes, may refer to the asymptomatic child or a teenager is suffering from Reye syndrome. An elevated level may also indicate an undiagnosed urea cycle enzymatic defect.

Low Ammonia Level

Some types of hypertension, such as malignant hypertension (Extremely high blood pressure that occurs suddenly and unexpectedly) and essential (unknown cause high blood pressure), may show low ammonia levels.

“Read Also: Albumin blood level test


Is there anything else I should know about NH3 Test?

Ammonia ranges may also be elevated in the presence of:
  • Gastrointestinal bleeding occurs when blood cells are hemolyzed in the intestines, causing the protein to be released.
  • Muscular exertion occurs when muscles are active and absorb ammonia when resting.
  • When using a tourniquet, ammonia levels in the blood sample can rise.
  • High protein intake – A high protein diet may cause ammonia buildup in some patients.
  • Prematurity – In rare cases, premature babies with respiratory distress can have very high ammonia levels.
  • Certain drugs are used, such as alcohol, barbiturates, diuretics, high-dose chemotherapy, valproic acid, and narcotics.
  • Using cigarettes
Ammonia tests can also be done on artery blood, but this is much less common than on veins. Although some professionals think that measuring arterial ammonia is more clinically useful, there is no universal agreement.
Some antibiotics, such as neomycin and metronidazole, may lower ammonia levels.

Can a blood ammonia test be used to detect or monitor ammonia poisoning?

No, in general. According to the Agency for Toxic Substances and Disease Registry, ammonia usually burns or irritates whatever it comes in contact with, but it is not a systemic poison. In liquid or vapour form, commercial ammonia can cause more severe burns than household ammonia. Still, both can harm the eyes, skin, respiratory tract, and, if swallowed, the mouth, throat, and stomach.

Can my elevated ammonia level rise again once it has returned to normal?

It is dependent on the reason for the increase in the first place. If you had a temporary condition, the ammonia level would most likely remain normal. If you have a chronic condition, it may worsen, and your health needs to be monitored. Consult with your healthcare provider to determine what is best for you.

Your doctor is the best person to explain your Ammonia levels test results and discuss what they may mean for your health, as well as whether any additional tests are necessary as a follow-up.
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