GI bleed --> hyperammonemia

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Hyperammonemia is due to bacterial degradation of blood (high in protein) into amines, amino acids, purines, and urea. Normally, liver has vast capacity to detoxify ammonia so it only is a problem (hepatic encephalopathy) in pts with liver compromise (cirrhosis) and/or Porto-systemic shunting (TIPSS).
 
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