An increase in blood ammonia can arise from excess production and/or decreased clearance. A number of conditions may be associated with exercise-associated hyperammonemia.
Patient selection: elevated ammonia during exercise
(1) chronic liver disease
(2) heat stress
(3) inherited metabolic disorder
(3a) phosphoglycerate kinase 1 (PGK1) deficiency
(3b) glycogen storage disease
(3c) myophosphorylase deficiency (McArdle disease)
The elevated ammonia has been suggested as a cause for easy fatigability in these conditions.
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