Increased ammonia production | Decreased ammonia clearance |
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Infections by urea-producing bacteria: Proteus mirablis, Klebsiella species, Escherichia coli, Morganella morganii, Providencia rettgeri, diphtheroids, Mycobacterium genavense, herpes simplex | Ureterosigmoidostomy |
Hematooncological disorders: multiple myeloma, chemotherapy for acute leukemia, bone marrow transplantation, 5-fluorouracil | Portosystemic shunts; congenital intrahepatic and extrahepatic |
Organ transplantation | Drug-induced: valproic acid, glycine, carbamazepine, ribavirin, sulfadiazine with pyrimethamine, salicylate |
Protein load and increased catabolism: severe exercise, seizures, starvation or trauma, total parenteral nutrition, gastrointestinal bleeding, steroid use | Inborn errors of metabolism: urea-cycle disorders, defects in β-oxidation of fatty acids, organic acidemias, disorders of pyruvate metabolism |