{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,23]],"date-time":"2025-10-23T06:59:43Z","timestamp":1761202783360,"version":"build-2065373602"},"reference-count":19,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T00:00:00Z","timestamp":1759881600000},"content-version":"vor","delay-in-days":7,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Emerg Medicine Australasia"],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Serum ammonia concentration is useful to identify adult onset inherited metabolic disorders in patients with encephalopathy, which are currently under\u2010recognised. We investigated the current ammonia requesting practises in an Australian Tertiary Hospital Emergency Department (ED) to determine if hyperammonemia is being considered in adults presenting with non\u2010hepatic encephalopathy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective chart review was performed on all adult patients with a serum ammonia requested from a single tertiary ED over a 12\u2009month period. The indications for ammonia testing, site of collection (ward vs. emergency department) and aetiology of hyperammonemia were recorded. An elevated serum ammonia level was defined as &gt;\u200960\u03bcmol\/L.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 597 serum ammonia tests were drawn from 439 patients, of which 177 (29.6%) tests were from patients with known inherited metabolic disorders. Ammonia ordering was higher on the ward (77.5%) than in the ED (22.5%); however, the ED had a higher proportion of orders with a hepatic indication for testing (89.8% vs. 63.4%). There were 666 emergency department presentations for confusion\/coma or encephalopathy. Of these patients, 52 (7.8%) had an ammonia measured, 25 (3.8%) from ED. Other indications for ammonia measurement included valproate toxicity, altered mental status, seizures, and atypical neurological symptoms. No new cases of suspected metabolic disease were identified.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Ammonia testing from the ED remains predominantly in the assessment of patients with hepatic disease, which is not a guideline\u2010recommended indication. Serum ammonia concentration is underutilised in cases of encephalopathy of unclear aetiology, potentially leading to missed diagnoses of metabolic disease.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/1742-6723.70153","type":"journal-article","created":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T04:20:14Z","timestamp":1759983614000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Measurement of Serum Ammonia in the\n                    <scp>ED<\/scp>\n                    : Lost Opportunities"],"prefix":"10.1111","volume":"37","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-3996-6707","authenticated-orcid":false,"given":"Ciselle","family":"Meier","sequence":"first","affiliation":[{"name":"Medical School The University of Western Australia  Perth Western Australia Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Catherine","family":"Manolikos","sequence":"additional","affiliation":[{"name":"Inborn Errors of Metabolism Service, Department of Endocrinology, Royal Perth Hospital  Perth Western Australia Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4611-9862","authenticated-orcid":false,"given":"Kharis","family":"Burns","sequence":"additional","affiliation":[{"name":"Medical School The University of Western Australia  Perth Western Australia Australia"},{"name":"Inborn Errors of Metabolism Service, Department of Endocrinology, Royal Perth Hospital  Perth Western Australia Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Damon A.","family":"Bell","sequence":"additional","affiliation":[{"name":"Medical School The University of Western Australia  Perth Western Australia Australia"},{"name":"Inborn Errors of Metabolism Service, Department of Endocrinology, Royal Perth Hospital  Perth Western Australia Australia"},{"name":"Department of Clinical Biochemistry, PathWest Laboratory Medicine, Royal\u00a0Perth and Fiona Stanley Hospital Network  Perth Western Australia Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,10,8]]},"reference":[{"volume-title":"StatPearls","year":"2023","author":"Ali R.","key":"e_1_2_10_2_1"},{"key":"e_1_2_10_3_1","first-page":"60","article-title":"Practice Guideline by the American Association for the Study of Liver Diseases and the European Association for the Study of the Liver","volume":"2014","author":"Vilstrup H.","year":"2014","journal-title":"Hepatology"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2016.12.003"},{"key":"e_1_2_10_5_1","unstructured":"Choosing Wisely Canada \u201cFive Tests and Treatment Questions: Canadian Association for the Study of Liver Disease \u201d2024."},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/imj.16053"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.14740\/jem750"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/8904_2015_435"},{"key":"e_1_2_10_9_1","first-page":"1","article-title":"Diagnostic Odyssey for Rare Diseases: Exploration of Potential Indicators","author":"Black N.","year":"2015","journal-title":"Policy Innovation Research Unit"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.2147\/TCRM.S93144"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/jimd.12100"},{"volume-title":"Acute Liver Failure","year":"2023","author":"Shah N. J.","key":"e_1_2_10_12_1"},{"key":"e_1_2_10_13_1","first-page":"US2019","article-title":"Serum Ammonia Levels: An Overused Test in the Evaluation of Altered Mental Status in Patients Without Chronic Liver Disease","author":"Schroeder M.","year":"2019","journal-title":"HVPAA National Conference"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.14309\/ajg.0000000000000343"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2022.06.001"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.3389\/fmed.2020.589825"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1478-3231.2011.02550.x"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pathol.2024.06.002"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1136\/flgastro-2021-101837"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1136\/flgastro-2021-101996"}],"container-title":["Emergency Medicine Australasia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/1742-6723.70153","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,23]],"date-time":"2025-10-23T06:58:46Z","timestamp":1761202726000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/1742-6723.70153"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10]]},"references-count":19,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2025,10]]}},"alternative-id":["10.1111\/1742-6723.70153"],"URL":"https:\/\/doi.org\/10.1111\/1742-6723.70153","archive":["Portico"],"relation":{},"ISSN":["1742-6731","1742-6723"],"issn-type":[{"type":"print","value":"1742-6731"},{"type":"electronic","value":"1742-6723"}],"subject":[],"published":{"date-parts":[[2025,10]]},"assertion":[{"value":"2025-05-06","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-09-22","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-10-08","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70153"}}