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(3) renal â glutamine break down in proximal tubule (combines with H+ -> NH4+ and eliminated) CAUSES OF HYPERAMMONAEMIA. Overproduction of ammonia. Protein/ amino acid load. gastrointestinal hemorrhage. gastric bypass. multiple myeloma. allogeneic stem cell transplantation.
Hyperammonemia in the Adult Critical Care Setting K. DAMS, W. MEERSSEMAN, and A. WILMER Introduction Ammonia is produced from the breakdown of proteins, aminoacids, purines, and pyrimidines. About half of the ammonia arising from the intestine is synthesized by bacteria, the remainder coming from dietary protein and glutamine. Ammonia is a highly toxic compound, particularly to the brain. When blood concentrations of ammonia are sufficiently elevated, respiratory alkalosis, cerebral edema, altered mental status, seizures, coma and death can ensue. The liver normally converts ammonia to urea in the Krebs-Henseleit cycle (urea cycle). Urea is a non-toxic com-pound excretable in the urine. Hyperammonemia is observed most often in patients with severe liver disease,