Hello, Ammonia is the end product of the metabolism of nitrogen-containing compounds, is neurotoxic at elevated concentrations. Normally liver clears almost all of the ammonia by converting it into glutamine and urea preventing entry into the systemic circulation. In advance liver disease or cirrhosis, the level of blood ammonia increases due to impaired liver function and shunting of blood around the liver. In addition, muscle wasting may increase ammonia level since muscle is also an important site for ammonia removal. So, when the liver is damaged, excess of ammonia can build up in the bloodstream and affect the function of the nervous system resulting in hepatic encephalopathy. So, excess of ammonia enters into systemic (blood) circulation causing The excess level of ammonia can be reduced by giving laxative (Lactulose) to prevent bacteria in the intestines from creating ammonia and by certain antibiotics such as Neomycin or Rifaximin which kill the bacteria which produce ammonia in the gut. Hope I have answered your query. Let me know if I can assist you further. Regards, Dr. Mohammed Taher Ali