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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.
If there is doubt about the claim of anosmia, try testing with ammonia solution. Ammonia causes a physical irritation and so will cause an abreaction even in the presence of anosmia. Denying a response to ammonia suggests malingering. Two important aspects of the optic nerve are visual acuity and visual field.