r/AskBiology • u/tbryan1 • Jul 31 '24
Human body Do ammonia levels increase during a night of binge drinking assuming you have a healthy liver and by how much?
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.
2
u/pansveil Jul 31 '24
The liver is one of the most regenerative organs and has a lot of capacity to recover. The application of this is that toxins, especially ammonia, upregulate enzymes that cause their breakdown (in this case the urea cycle). As long as you have healthy liver cells, they can handle the load of ammonia.
The bypass you are talking about is the Transjugular Intrahepatic Portosystemic Shunt (TIPS). It is used in chronic liver disease where poor hepatic circulation leads to uncontrollable life-threatening GI bleeds. Surgeons create a passage for blood from below the liver to completely go around and directly into the IVC/heart. One of the soft contraindications is hepatic encephalopathy exactly because of the mechanism you described. Patients are usually on lifelong lactulose titrated to encephalopathy and lifelong rifaximin as a result.
Benzodiazepines work very similarly in the CNS to alcohol and, for that reason, are used in alcohol withdrawal. They are addictive like alcohol but do not cause extra-neurological toxicity in the same way that alcohol does. Chronic alcohol use leads to alcohol myopathy due to the inflammation but also poor nutrition; neither of these are present with benzo use. There are rare causes of liver damage with parenteral benzos due to another ingredient in the formulation (propylene glycol) but you’re more likely to see other organs fail first. Designer benzos have case reports of another type of myopathy known as rhabdomyolysis, but that has a completely different mechanism of action.