1 Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, USA.
2 Gastroenterology Section, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA.
3 Division of Hepatology, Baylor Scott and White, Dallas, Texas, USA.
Hepatic encephalopathy is a clinical diagnosis. However, many clinicians measure ammonia levels in hospitalized patients presenting with hepatic encephalopathy. In this editorial, we review the results of an important study by Haj and Rockey (see Haj M and Rockey DC. Ammonia levels do not guide clinical management of patients with hepatic encephalopathy caused by cirrhosis. Am J Gastroenterol [Epub ahead of print October 14, 2019.]). The authors examined the management decisions effected affected by and outcomes associated with (i) ordering an ammonia level and (ii) knowing the ammonia level. They find found that ammonia level determination did not impact affect clinical decision-making or patient outcomes. These persuasive data demonstrate the limited clinical utility of ammonia levels and highlight the need for testing stewardship to dissuade unnecessary use through educational efforts and decision supports.