Elevation of Blood Ammonium in Hemorrhagic Shock

Horsley, J. Shelton; Cosse, Jerome J. De; Hood, Margaret; Sager, Naomi; Randall, Henry T.; Roberts, Kate

doi:10.1097/00000658-195712000-00009

Cited by 7 publications

(5 citation statements)

References 37 publications

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“…12 The biochemical mechanism of disordered metabolism from cellular dysoxia leading to elevated plasma ammonia in hemorrhagic shock was identified in animal studies by the 1940s to 1980s. [1][2][3][4] Liver dysfunction reduces hepatic ammonia detoxification by disordering glutamine synthesis in the pericentral hepatocytes and urea synthesis in the periportal hepatocytes. 6,7 Renal dysfunction decreases excretion of urea ammonium and increases plasma ammonium in the renal vein.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4] Crowell et al 5 reported that hemorrhage decreases blood flow through the portal vein reducing total hepatic blood flow, and that ischemia also occurs from the periportal to centrilobular areas leading to centrilobular necrosis in irreversible shock. Haussinger 6 and Turner and Whittle 7 reported that glutamine synthesis is localized to the pericentral hepatocytes, whereas urea synthesis is localized to the periportal hepatocytes.…”

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confidence: 99%

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Clinical Significance of Plasma Ammonia in Patients With Traumatic Hemorrhage

Hagiwara

Sakamoto²

2009

Journal of Trauma: Injury, Infection &Amp; Critical Care

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Clinical Significance of Plasma Ammonia in Patients With Traumatic Hemorrhage

Hagiwara

Sakamoto²

2009

Journal of Trauma: Injury, Infection &Amp; Critical Care

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“…Therefore ammonia excretion will be diminished and the plasma ammonia level will be increased. (13,18) Enzymes of the intestinal bacteria which acts on it produces ammonia which diffuses freely and furthermore the liver cannot detoxify ammonia due to its impairment because of reduced hepatic blood flow. (15,16,17) A similar study was done by Hagiwara and Sakamoto which included 282 trauma patients in two groups, with and without intra-abdominal hemorrhage.…”

Section: Discussionmentioning

confidence: 99%

“…(13,18) Enzymes of the intestinal bacteria which acts on it produces ammonia which diffuses freely and furthermore the liver cannot detoxify ammonia due to its impairment because of reduced hepatic blood flow. (15,16,17) A similar study was done by Hagiwara and Sakamoto which included 282 trauma patients in two groups, with and without intra-abdominal hemorrhage. The mean ammonia level in the first group was significantly higher, 113 ± 52.2 versus 55.4 ± 20.8μg/dl.…”

Section: Discussionmentioning

confidence: 99%

The role of plasma ammonia level in detecting intra-abdominal hemorrhage following blunt abdominal trauma

Kasim¹

2021

KJMS

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“…Intestinal bacterial enzymes acting on it produces ammonia which is freely diffusible and moreover liver in not fit for detoxification of ammonia. [9]…”

Section: Introductionmentioning

confidence: 99%

Arterial ammonia levels: Prognostic marker in traumatic hemorrhage

Singla

Kaur

et al. 2016

Int J App Basic Med Res

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Background:In blunt trauma, extent of hemorrhage cannot be determined by physical examination, and vital signs may also not give clear picture in all the patients, especially young healthy ones. Hemorrhagic shock has been reported to increase blood ammonia levels. Arterial ammonia was analyzed in blunt trauma abdomen patients and correlated with shock index (SI). Its predictive value was determined for timely decision of intervention.Materials and Methods:Hundred blunt trauma abdomen patients presented in the emergency ward of tertiary care hospital were included in the study. Group I comprised 62 patients requiring either blood transfusion ≥2 units and/or intervention to control bleeding within 24 h following admission. Group II had 38 patients: Not requiring transfusion/intervention during hospital stay. Arterial blood sample was taken immediately after admission; ammonia was analyzed within 20 min of sampling on Cobas 6000 (Roche). SI was calculated. Predictive value of ammonia was determined using receiver operating characteristic curve.Results:Ammonia levels and SI were significantly (P < 0.001) higher in Group I compared to Group II patients (68.55 ± 14.36 umol/L vs. 37.55 ± 7.41 umol/L and 1.28 ± 0.5 vs. 0.74 ± 0.12, respectively). Significantly higher number of patients in Group I (88.7% vs. 13%) had SI > 0.9. Ammonia levels were significantly higher in patients with complications and in those expired.Conclusions:Ammonia levels were significantly higher in patients requiring blood transfusion/intervention in 24 h of admission. The best cutoff value to maximize sensitivity and specificity was ammonia >58.85 μmol/L. Ammonia estimation at admission can be clinically significant indicator of traumatic hemorrhage needing intervention.

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Elevation of Blood Ammonium in Hemorrhagic Shock

Cited by 7 publications

References 37 publications

Clinical Significance of Plasma Ammonia in Patients With Traumatic Hemorrhage

Clinical Significance of Plasma Ammonia in Patients With Traumatic Hemorrhage

The role of plasma ammonia level in detecting intra-abdominal hemorrhage following blunt abdominal trauma

Arterial ammonia levels: Prognostic marker in traumatic hemorrhage

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