Some of the lab work drawn in the ED has come back. The BAL is 320 mg/dL, and the bloodammonia (NH3) level is 155 mcg/dL. His total protein is 5.2 g/dL and albumin is 2.1 g/dL
What do these values indicate?
• The BAL is far above the 100 mg/dL level considered to be intoxication in most areas; in fact, it is
above the critical value of greater than 300 mg/dL. Because this man can have this level of blood
alcohol with any semblance of consciousness indicates that he has developed a high tolerance to
alcohol.
• When the liver begins to fail or is seriously compromised during an ongoing inflammatory
reaction, the function of the liver is compromised. The liver converts NH3 to urea, which is excreted.
In liver failure, ammonia levels rise, causing mental confusion and encephalopathy. The danger of
the high NH3 level is that the ammonia will cross over the blood-brain barrier and cause hepatic
encephalopathy. John Doe's NH3 level is considerably above normal (10 to 80 mcg/dL) and is
consistent with a significant degree of liver dysfunction.
• The decreased protein and albumin levels reflect a malnourished state.
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