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Hi all, The good news is that I've finally gotten DS 16 to do blood work. The chemistry and basic IgX results are now released, but annoyingly while his MD is out, so I can't ask about the item(s) that concern me. Here are the key abnormal items so far. I'm especially puzzled about the Ammonia. Ammonia 94 (11-32 umol/L) H IgA 42 (68- 259 mg/dL) L IgG 851 (522-1703 mg/dL) IgM 53 (28- 179 mg/dL) The IgA can explain why he comes down with any and all colds, though it's not super low. However.... WTF is with the Ammonia!? I know how much Ammonia burns, so at almost 3x max normal, I am concerned. Here's where I wish I was an MD/RN. Now I read how neurotoxic it is -- could cause a lot of the behavioral symptoms we associate with PANS -- and that it should be turned into urea in the liver. He's certainly on enough meds that there can be interactions w liver, kidneys. (but BUN, creatinine are just fine). Anyone experienced this? What is the differential diagnosis? Could it be a false positive, because of a meal he ate, or his stress, or how the sample was handled? Here's the basics I've found so far: Ammonia is produced from the deamination of amino acids in the muscle and the kidneys, and by the action of bacteria in the colon and small intestine. Ammonia is neurotoxic and is detoxified in the body by conversion to urea via the urea cycle in the liver, thus maintaining a low concentration of ammonia in the circulation. It can also be incorporated into glutamate to form glutamine, an important metabolic fuel for some tissues, and a source of amino groups in purines and pyrimidines.