My child has had periodic hyperammonemic episodes sometimes characterized by lethargy and other times hyperactivity or agitation. Why does my child exhibit these contradictory symptoms?

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My child has had periodic hyperammonemic episodes sometimes characterized by lethargy and other times hyperactivity or agitation. Why does my child exhibit these contradictory symptoms?

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The interaction between ammonia and the brain is not well understood . The elevations in ammonia and the other urea cycle related amino acids (like glutamine) can affect different parts of the brain in different ways. Sometimes this makes a child sleepy and sometimes it makes them agitated. Both can be signs of an onset of hyperammonemia. It really depends on which part of the brain and which chemicals are affected first. In general, however, agitation and hyperactivity tend to precede lethargy in a hyperammonemic episode.

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