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Commentary to Aby et al: serum ammonia use – unnecessary, frequent and costly
  1. Johannes Häberle1,
  2. James Nurse2,3,
  3. Fanny Mochel4
  1. 1 Department of Pediatrics, Division of Metabolism, University Children's Hospital Zürich, Zurich, Switzerland
  2. 2 Paediatrics, Southampton University Hospitals NHS Trust, Southampton, UK
  3. 3 Faculty of Medicine, University of Southampton, Southampton, UK
  4. 4 Département de génétique, Hôpital Universitaire Pitié Salpêtrière, Paris, Île-de-France, France
  1. Correspondence to Dr Johannes Häberle, University Children's Hospital Zürich, 8032 Zurich, Zürich, Switzerland; Johannes.Haeberle{at}

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We read with much interest the retrospective analysis of serum ammonia tests performed in a large healthcare system.1 The authors describe a sizeable proportion of the serum ammonia tests as ‘inappropriately ordered’, and hence to be avoided. They argue that this is particularly the case in patients with hepatic encephalopathy but do acknowledge two conditions that warrant testing: acute liver failure (ALF) and urea cycle disorders (UCDs). These indications accounted for just 0.9% of the tests reviewed.

We agree that unnecessary medical intervention should be avoided but see two important points where the authors are overshooting:

  1. Aby et al see any use of serum ammonia outside of ALF and UCDs as …

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  • Contributors This letter was drafted by JH with additions and revisions made by FM and JN.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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