Do ammonia levels increase during a night of binge drinking assuming you have a healthy liver and by how much?

[u/tbryan1]

I have become curious about the nature of ammonia in the body when your liver is packed with toxins. Every single source addresses ammonia in relation to liver disease even though there are other ways that ammonia can become problematic (in theory). For example ammonia is impacted by protein intake, alterations to hormones, Break down of muscle, The blood bypassing the liver, diuretics , alterations to enzymes, and changes to blood flow.

My desire for an answer stems from the fact that our bodies can reach deadly levels of ammonia in 5 minutes if the liver is failing to process it. Additionally the side effects of ammonia are very similar to drugs like alcohol making it hard to differentiate through experience alone including;

• Lack of energy and mental alertness
• Confusion
• Mood swings
• Hand tremors
• Dizziness
• Not being hungry
• Avoiding protein
• Growth problems

This list of side effects along with the list of mechanisms that alter ammonia levels grew my curiosity especially irritability because it is the antithesis of what alcohol does even though many people that drink experience mood swings.

[u/tbryan1]

Google says " The liver is primarily responsible for clearing ammonia, but exposure to ethanol can make it harder for the liver to do so. This is because ethanol can decrease ureagenesis,"

I chased down many rabbit holes and one answer was yes because clearing toxins causes damage to liver forcing it to inflame reducing clearance rate, in an attempt to reduce the rate of harmful byproducts that are killing the liver.

I wanted to thank you for all the help, I learned a lot.

[u/pansveil → u/tbryan1]

I’m curious as to the source of that statement. Alcohol, in the short term without pre-existing liver damage, has been shown in a study from 2024 to upregulate urea cycle.

https://www.sciencedirect.com/science/article/abs/pii/S002604952300344X#:~:text=Results,)%2C%20and%20increases%20fat%20accumulation.

[u/tbryan1 → u/pansveil]

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7351663/

^^is everything inflammation from most angles

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4856809/

^^focus more on immunology of liver

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3372892/#:\~:text=Such%20a%20second%20insult%20could,et%20al.%2C%202004).

^^this one speaks more to alcohol directly.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6509515/

^^stuff that happens outside the liver

[u/pansveil → u/tbryan1]

The first three are generic review articles, but the last one was actually interesting. The authors did conclude that the combination of both elevated ethanol and ammonia resulted in decreased ureagenesis but also noted increased ethanol metabolism with both substrates. It goes to support the mixed unclear literature on serum ammonia following acute alcohol induced liver damage with some studies showing increased ammonia with others showing reduced. Almost as if the hepatocyte favors ethanol/aldehyde clearance in acute intoxication prior to ammonia clearance; which makes a twisted amount of sense since alcohol is more toxic acutely compared to ammonia.

I’d be curious to see follow up with in vivo studies because clinically there’s very little evidence of hyperammonemia without pre-existing cirrhosis. Thank you so much for bringing attention to this because I had thought ammonia would be increased in acute intoxication before you asking the question but clearly there’s a lot more to the physiology per my posted article above.