Treating Hyperammonemia

[Jamiu22]

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I know Lactulose is typically used to treat this condition by acidifying the intestines which would then bind to the ammonium ion (NH4+) for excretion (FA2012, pg 110)

I'm trying to relate this back to drug elimination from renal tubules... we typically acidify the urine to get rid of weak bases, while we alkalinize the urine to get rid of weak acids..

...from both, what I don't get is since you are acidifying the GI with lactulose, why would it lead to trapping of ammonium ion when it's in fact a weak acid? should you be alkalinizing the GI to get rid of ammonium?

RRR!!! what am I getting wrong here???? somebody help.

 

[MLT2MT2DO]

Because it's NH3 in the intestines, which is a weak base turning it into NH4+ is what traps it?

Could be totally wrong on this, this has just been my understanding all along.

 

[Jamiu22]

Because it's NH3 in the intestines, which is a weak base turning it into NH4+ is what traps it?

Could be totally wrong on this, this has just been my understanding all along.

Thanks man... you've got to be right about this.... it make sense from what you've explained. I read FA again, and they could have worded it better.

 

[loveoforganic2]

Yep, ammonia is a weak base - those protons do not come off under anything like physiologic conditions

 

[MLT2MT2DO]

Thanks man... you've got to be right about this.... it make sense from what you've explained. I read FA again, and they could have worded it better.

This is the same thing that happens in the kidney as well, only reason I made the assumption about intestine

 

[CaptainSSO]

Worth noting here that

Ammoni*a* = NH3, a non-ionized weak base as LoO mentioned. Hence it's not ionized and will cross cell membranes

Ammoni*um* = NH4+, ionized and won't cross membranes as readily