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


Differential diagnosis:

(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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