hyperammonemia

hyperammonemia, disorder due to excessive amounts of ammonia in the blood caused by a genetic defect present at birth, by a genetic defect acquired in adulthood, or by liver disease. Ammonia is metabolized by the liver to produce a nitrogenous compound known as urea that is excreted in the urine. Thus, abnormally high levels of ammonia in the body result in excessive production of urea, which can be detected in the blood.

Hyperammonemia is one of three known inherited metabolic disorders affecting urea formation in the body. (The other two are called citrullinemia and argininosuccinic aciduria.) Normally, the metabolic pathway of urea formation is carried out, step by step, by a series of organic catalysts, or enzymes. In individuals born with hyperammonemia, there is a decrease in the activity of two of these enzymes, namely, carbamyl phosphate synthetase and ornithine transcarbamylase. In citrullinemia, the defective enzyme is argininosuccinate synthetase; in argininosuccinic aciduria, it is the enzyme argininosuccinase. All three disorders are characterized by elevated concentrations of ammonia in the blood after the ingestion of proteins and by impairment of the central nervous system (the cells of the brain are highly sensitive to ammonia). The poorly metabolized compounds in the metabolic pathway of urea formation are also found in greater concentration in the blood, cerebrospinal fluid, and urine.