My husband is 81 years old. Recently he has developed the following symptoms: very unsteady on feet, extreme shaking of hands to the point of writing not legible, confusion, going to sleep the minute he gets still, extreme personality change. i thought it was dementia, local dr did blood work up and his ammonia level was 88 he immediately put him on Generlac and his symptoms got better. His hands no longer shook, he didn't drop off to sleep and his personality seemed to be getting back to normal. The ammonia levels dropped to 68 then 44. They said to come back in three weeks, in less than two weeks his personality changed again and he was very unsteady on his feet and confusion got worse so we went back to the doctor. We have had to put a rail on our bed because he keeps falling out of the bed in the middle of the night. His ammonia was back up to 88 the next week it was 25 but his symptoms are still there. They did a CT scan and told us he has adrenal adenomas, an ultrasound is scheduled for Thursday. Why is his ammonia on such a roller coaster ride and is this something that we need to be really concerned about.