Why does my son have high ammonia and liver enzymes at 4?

Question

Hello doctor,

My four-year-old son had Kasai surgery when he was two years old. Recently noticed he is becoming super irritable, not eating properly, sleeping all day, and crying at night. He is having shaky hands when reaching for toys. The ammonia level came back high at 285, and liver enzymes were elevated.

What should I do, doctor?
Is he developing any serious complications from the surgery?

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern.

These symptoms are very concerning in a child with prior Kasai surgery (for biliary atresia).

High ammonia (285) level with symptoms like,

Irritability.
Excessive sleepiness.
Night crying.
Poor appetite.
Shaky hands

can suggest hepatic encephalopathy or worsening liver dysfunction. This is a medical emergency for your child. An elevated liver enzyme can lead to neurological symptoms. It is possible due to a post-Kasai liver failure or complication. You should immediately take him to the nearest hospital with pediatric liver or gastro support immediately

Do not wait at home, as high ammonia can affect the brain of your child. He may need urgent treatment to lower ammonia via intravenous fluid administration, medication support, and monitoring.

In the meantime, do not give your child high-protein heavy meals until seen by a doctor (small carbohydrate-based feeds are safer)

Please share his current height, weight, fever status, jaundice, abdominal swelling, or vomiting if present, while you arrange emergency care and review as soon as possible.

I hope this information helps you.

Feel free to ask further queries.

Thank you.