THE METABOLISM OF THE VOLATILE AMINES: VII. THE CLINICAL SIGNIFICANCE OF TWO COMPONENTS OF THE BLOOD AMMONIA LEVEL.

BLOOD AMMONIA LEVELS CONSIST OF TWO COMPONENTS: ammonia present in blood at the time of shedding, termed "free" ammonia, and ammonia produced by the deamidating action of the alkali reagents. Blood of healthy people contained little or no "free" ammonia while blood of patients with chronic liver disease occasionally showed levels up to 1.2 mug./ml. Patients with hepatic encephalopathy had significantly elevated levels which usually fell to zero following therapy. Levels of "free" ammonia above 0.6 mug./ml. were diagnostic of hepatic encephalopathy in patients suffering from unexplained neurological disorders.The rate of formation of ammonia by the alkali reagents was increased in patients with hepatic necrosis and was depressed in those with chronic hepatitis. The ammonia appeared to arise from the deamidation of glutamine and asparagine, present in blood in both the free and peptide forms.