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Ammonia results from the breakdown of protein in the body. Most ammonia in the body forms when protein is broken down by bacteria in the intestinal tract. The liver normally converts ammonia into urea, which is then eliminated in urine. If the liver is unable to convert ammonia into urea (because of cirrhosis or severe hepatitis, for instance), ammonia levels rise in the blood. When excess amounts of ammonia build up in the blood, a person may show symptoms of abnormal brain function (called encephalopathy), such as unclear thinking, extreme sleepiness, a characteristic hand tremor (called asterixis or flapping tremor), or coma. A high protein diet may elevate ammonia levels.

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