Brief Answer: He may have liver or renal involvement. Detailed Answer: Hello XXXXX Thanks for writing to HCM Sorry to hear about his chronic illness. High level of ammonia in blood indicates liver or renal involvement.Ammonia is normally excreted in urine,so high levels generally occur when liver or kidneys are not functioning properly. He need proper clinical examination and few more investigations. Other investigations include routine hemogram,RBS(Random blood sugar),Liver function test(LFT),Complete RFT(includes serum creatinine level,creatinine clearance,GFR,BUN,Serum electrolytes like sodium,potassium,calcium,phosphorus,chloride,bicarbonate),Ultrasound of abdomen. Further investigations can be done if needed. Ultrasound of abdomen,LFT and RFT are very important in determining underlying etiology. Proper treatment depend upon clinical findings and investigation reports. He may need to regulate fluid and protein control if hepatic or renal involvement is diagnosed. Besides lactulose,he may need other medicines depending upon severity.He may need to taper the dose of lactulose due to diarrhea. Any source of gastrointestinal bleeding should be identified because it will aggravate the situation. Neomycin may also be used to reduce ammonia production by intestinal bacteria. Get well soon. Hope I have answered your question. Further queries are most welcome. Take Care Dr.Indu XXXXXXX

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