Ammonia Measurement in Cirrhosis: ISHEN International Delphi Consensus Recommendations

Ammonia is a neurotoxin implicated in the pathogenesis of hepatic encephalopathy (HE). Yet, the clinical utility of blood ammonia measurement in patients with cirrhosis remains controversial due to methodological variability, inconsistent interpretation, and lack of standardized guidance. The aim of this consensus document, developed by the International Society for Hepatic Encephalopathy and Nitrogen Metabolism (ISHEN), is to provide evidence-based recommendations on the role of ammonia measurement in the diagnosis, monitoring, and treatment of patients with cirrhosis.