Figure 2.

A schematic representation of the sources of ammonia production and its excretory pathway. Ammonia is primarily generated by the small intestine, metabolised in the liver into urea and subsequently excreted in urine as urea and ammonium. The liver’s urea cycle pathway becomes the most vital process to eliminate ammonia. The ammonia level can become high if there is a problem in liver, urea cycle pathway or if they both are normal but are overwhelmed by increased production. In our case, we propose a pathological additional source of ammonia in the colon via urease-producing bacteria and increased absorption of ammonia through the necrosed bowel.