{"id":9127,"date":"2020-04-23T03:28:52","date_gmt":"2020-04-23T01:28:52","guid":{"rendered":"https:\/\/www.synevo.ro\/product\/amoniac\/"},"modified":"2026-02-18T23:41:23","modified_gmt":"2026-02-18T21:41:23","slug":"amoniac","status":"publish","type":"product","link":"https:\/\/old.synevo.md\/ru\/shop\/amoniac\/","title":{"rendered":"\u0410\u043c\u043c\u0438\u0430\u043a"},"content":{"rendered":"<p><strong><em>\u041e\u0431\u0449\u0430\u044f \u0438\u043d\u0444\u043e\u0440\u043c\u0430\u0446\u0438\u044f <\/em><\/strong><\/p>\n<p>Amoniacul, principalul produs al catabolismului amino-acizilor, este sintetizat prin actiunea bacteriilor asupra proteinelor intestinale si hidroliza glutaminei in rinichi. In mod normal, ficatul inlatura cea mai mare cantitate de amoniac prin circulatia portala si transforma amoniacul in uree (ciclul ureei Krebs-Henseleit) care apoi este excretata in urina. Acest proces de formare a ureei este esential pentru organism, deoarece nivelurile crescute de amoniac in sange afecteaza echilibrul acido-bazic si activitatea cerebrala<sup>1<\/sup>.<\/p>\n<p>La pH-ul fiziologic, amoniacul este prezent aproape in intregime sub forma sa ionizata (NH4<sup>+<\/sup>). Hiperamoniemia este rezultatul tulburarilor structurale sau functionale ale metabolismului azotat hepatic<sup>5<\/sup>.<\/p>\n<p><strong><em>Recomandari pentru determinarea amoniacului<\/em><\/strong><\/p>\n<p style=\"padding-left: 30px;\">-diagnosticul sindromului Reye;<\/p>\n<p style=\"padding-left: 30px;\">-stabilirea evolutiei hepatopatiilor severe si a raspunsului acestora la tratament;<\/p>\n<p style=\"padding-left: 30px;\">-chimioterapie agresiva (poate conduce la hiperamoniemie chiar in absenta unei disfunctii hepatice);<\/p>\n<p style=\"padding-left: 30px;\">-terapia cu acid valproic (poate conduce la hiperamoniemie tranzitorie, in special la copii);<\/p>\n<p style=\"padding-left: 30px;\">-anumite anomalii metabolice ereditare (deficit de ornitin-carbamoiltransferaza, citrulinemie, acidurie arginin-succinica);<\/p>\n<p style=\"padding-left: 30px;\">-cazuri inexplicabile de letargie si varsaturi, de encefalopatie sau la orice nou-nascut cu deterioare neurologica de cauza incerta;<\/p>\n<p style=\"padding-left: 30px;\">-monitorizarea pacientilor cu alimentatie parenterala totala<sup>1;3;5<\/sup>.<\/p>\n<p><strong><em>Pregatire pacient <\/em><\/strong>\u2013 \u00e0 jeun (pe nemancate); se va evita fumatul inaintea recoltarii<sup>4<\/sup>.<\/p>\n<p><strong><em>Specimen recoltat <\/em><\/strong>\u2013 sange venos; se va evita staza prelungita; se vor consemna antibioticele administrate pacientului deoarece acestea pot reduce amoniemia<sup>1;4<\/sup>.<\/p>\n<p><strong><em>Cantitate recoltata<\/em><\/strong> \u2013 cat permite vacuumul<sup>4<\/sup>.<\/p>\n<p><strong><em>Recipient de recoltare <\/em><\/strong>\u2013 vacutainer cu EDTA K3 ce va fi transportat la laborator pe gheata<sup>4<\/sup>.<\/p>\n<p><strong><em>Prelucrare necesara dupa recoltare<\/em><\/strong> \u2013 se separa plasma prin centrifugare rapida in 30 minute; tubul trebuie sa ramana inchis ermetic pana in momentul testarii<sup>4<\/sup>.<\/p>\n<p><strong><em>Cauze de respingere a probei <\/em><\/strong>\u2013 specimen hemolizat<sup>4<\/sup>.<\/p>\n<p><strong><em>Stabilitate proba <\/em><\/strong>\u2013 daca proba nu se poate lucra imediat, plasma separata si pastrata in tuburi inchise ermetic va fi congelata la -20 \u00baC unde este stabila <em>cateva zile<\/em>; probele recoltate in afara sediului laboratorului Grozovici vor fi transportate in recipientele pentru probe congelate<sup>4<\/sup>.<\/p>\n<p><strong><em>Metoda <\/em><\/strong><em>- <\/em><span style=\"text-decoration: underline;\">enzimatica (cu glutamat dehidrogenaza)<\/span><sup>4<\/sup>.<\/p>\n<p><strong><em>Valori de referinta<\/em><\/strong><\/p>\n<p style=\"padding-left: 30px;\">Femei: 11-51 \u03bcmol\/L<\/p>\n<p style=\"padding-left: 30px;\">Barbati: 16-60 \u03bcmol\/L<\/p>\n<p><em>Factor de conversie: \u03bcmol\/L x 1.703 = \u03bcg\/dL<\/em><em><sup>3<\/sup><\/em><em>.<\/em><\/p>\n<p><strong><em>Limita de detectie <\/em><\/strong>\u2013 8.2 \u03bcmol\/L (14 \u03bcg\/dL)<sup>3<\/sup>.<\/p>\n<p><strong><em>Interpretarea rezultatelor<\/em><\/strong><\/p>\n<p><span style=\"text-decoration: underline;\"><strong>Hiperamoniemia<\/strong><\/span> se intalneste in urmatoarele situatii:<\/p>\n<p style=\"padding-left: 30px;\">-afectiuni hepatice grave (necroza hepatica severa, ciroza in stadiu terminal, dupa hepatectomie); in ciroza poate aparea dupa realizarea unui sunt portocav;<\/p>\n<p style=\"padding-left: 30px;\">-coma hepatica (valorile nu se coreleaza cu gradul encefalopatiei)<sup>3<\/sup>;<strong><em>\u00a0<\/em><\/strong><\/p>\n<p style=\"padding-left: 30px;\">-sindrom Reye;<strong><em>\u00a0<\/em><\/strong><\/p>\n<p style=\"padding-left: 30px;\">-hiperamoniemia tranzitorie a nou-nascutului (de etiologie necunoscuta; poate fi fatala in primele 48 ore);<strong><em>\u00a0<\/em><\/strong><\/p>\n<p style=\"padding-left: 30px;\">\u00a0-defecte in ciclul ureei<sup>1<\/sup>;<strong><em>\u00a0<\/em><\/strong><\/p>\n<p style=\"padding-left: 30px;\">-chimioterapia in doze mari;<strong><em>\u00a0<\/em><\/strong><\/p>\n<p style=\"padding-left: 30px;\">-terapia cu acid valproic;<strong><em>\u00a0<\/em><\/strong><\/p>\n<p style=\"padding-left: 30px;\">-mielom multiplu (mai ales cu determinari meningiene)<sup>5<\/sup>;<strong><em>\u00a0<\/em><\/strong><\/p>\n<p style=\"padding-left: 30px;\">-hemoragii digestive;<strong><em>\u00a0<\/em><\/strong><\/p>\n<p style=\"padding-left: 30px;\">-infectii de tract urinar cu distensie si staza;<strong><em>\u00a0<\/em><\/strong><\/p>\n<p style=\"padding-left: 30px;\">-alimentatie parenterala totala<sup>1;3;5<\/sup>.<strong><em>\u00a0<\/em><\/strong><\/p>\n<p><span style=\"text-decoration: underline;\"><strong>Scaderi<\/strong><\/span> ale amoniemiei se inregistreaza in hiperornitinemie (deficit de activitate a ornitinaminotransferazei) cu atrofie in spirala a coroidei si a retinei<sup>3<\/sup>.<strong><em>\u00a0<\/em><\/strong><\/p>\n<p><strong><em>Limite si\u00a0 interferente<\/em><\/strong><\/p>\n<p>Nivelurile amoniemiei variaza in functie de ingestia de proteine. Efortul poate induce cresteri tranzitorii<sup>1<\/sup>.<\/p>\n<p>O sursa cunoscuta de formare spontana de amoniac o reprezinta activitatea crescuta a enzimei GGT care accelereaza descompunerea glutaminei<sup>4<\/sup>.<\/p>\n<p>Aplicarea stransa a garoului poate determina cresterea amoniemiei<sup>1;4<\/sup>.<\/p>\n<p>\u2022 Medicamente<\/p>\n<p style=\"padding-left: 30px;\"><strong><span style=\"text-decoration: underline;\">Cresteri<\/span>:<\/strong> acetazolamida, asparaginaza, clortalidona, acid etacrinic, acid valproic, felbamat, furosemid, hidroflumetiazid, rasini schimbatoare de ioni, izoniazid, tiazide.<\/p>\n<p style=\"padding-left: 30px;\"><span style=\"text-decoration: underline;\"><strong>Scaderi<\/strong><\/span>: cefotaxim, difenhidramina, kanamicina, lactobacillus acidophilus, levodopa, inhibitori MAO, neomicina, tetraciclina, trometamina<sup>2<\/sup>.<\/p>\n<p>\u2022 Interferente analitice<\/p>\n<p>Hemoliza determina false cresteri ale amoniemiei deoarece continutul eritrocitelor in amoniac este de 3 ori mai mare decat cel al plasmei<sup>4<\/sup>.<\/p>\n<p><span style=\"font-size: small;\">\u00a0<\/span><\/p>\n<p><span style=\"font-size: small;\">\u0411\u0438\u0431\u043b\u0438\u043e\u0433\u0440\u0430\u0444\u0438\u044f<\/span><\/p>\n<p><span style=\"font-size: small;\">1. Frances Fischbach. Chemistry studies. In A Manual of Laboratory and Diagnostic Tests. Lippincott Williams &amp; Wilkins, USA, 8 Ed., 2009, 362-363.<\/span><\/p>\n<p><span style=\"font-size: small;\">2. Frances Fischbach. Effects of the Drugs on Laboratory Tests. In A Manual of Laboratory and Diagnostic Tests. Lippincott Williams &amp; Wilkins, USA, 8 Ed., 2009, 1224.<\/span><\/p>\n<p><span style=\"font-size: small;\">3. Jacques Wallach. Analizele de sange. In Interpretarea testelor de diagnostic. Editura Stiintelor Medicale, Romania, 7 Ed., 2001, 52-53.<\/span><\/p>\n<p><span style=\"font-size: small;\">4. Laborator Synevo. Referinte specifice tehnologiei de lucru utilizate 2010. Ref Type: Catalog.<\/span><\/p>\n<p><span style=\"font-size: small;\">5. Lothar Thomas. Metabolic parametrs. In Clinical Laboratory Diagnostics-Use and Assessment of Clinical Laboratory Results. TH-Books Verlagsgesellschaft mbH, Frankfurt \/Main, Germany, 1 Ed., 1998, 186-192.<\/span><\/p>","protected":false},"excerpt":{"rendered":"<p>\u0410\u043c\u043c\u0438\u0430\u043a \u043e\u0431\u0440\u0430\u0437\u0443\u0435\u0442\u0441\u044f \u0432 \u0442\u043e\u043b\u0441\u0442\u043e\u0439 \u0438 \u0442\u043e\u043d\u043a\u043e\u0439 \u043a\u0438\u0448\u043a\u0435 \u0432 \u0440\u0435\u0437\u0443\u043b\u044c\u0442\u0430\u0442\u0435 \u043a\u0430\u0442\u0430\u0431\u043e\u043b\u0438\u0437\u043c\u0430 \u0430\u043c\u0438\u043d\u043e\u043a\u0438\u0441\u043b\u043e\u0442 \u043f\u043e\u0434 \u0432\u043e\u0437\u0434\u0435\u0439\u0441\u0442\u0432\u0438\u0435\u043c \u043a\u0438\u0448\u0435\u0447\u043d\u043e\u0439 \u043c\u0438\u043a\u0440\u043e\u0444\u043b\u043e\u0440\u044b, \u043e\u0442\u043a\u0443\u0434\u0430 \u043a\u0440\u043e\u0432\u044c\u044e \u043f\u0435\u0440\u0435\u043d\u043e\u0441\u0438\u0442\u0441\u044f \u0432 \u043f\u0435\u0447\u0435\u043d\u044c \u0434\u043b\u044f \u043f\u0440\u0435\u043e\u0431\u0440\u0430\u0437\u043e\u0432\u0430\u043d\u0438\u044f \u0432 \u043c\u043e\u0447\u0435\u0432\u0438\u043d\u0443 \u043f\u043e\u0441\u0440\u0435\u0434\u0441\u0442\u0432\u043e\u043c \u0446\u0438\u043a\u043b\u0430 \u043e\u0431\u0440\u0430\u0437\u043e\u0432\u0430\u043d\u0438\u044f \u043c\u043e\u0447\u0435\u0432\u0438\u043d\u044b.<\/p>\n<p>\u041c\u043e\u0447\u0435\u0432\u0438\u043d\u0430 \u044f\u0432\u043b\u044f\u0435\u0442\u0441\u044f \u0432\u043e\u0434\u043e\u0440\u0430\u0441\u0442\u0432\u043e\u0440\u0438\u043c\u044b\u043c \u0441\u043e\u0435\u0434\u0438\u043d\u0435\u043d\u0438\u0435\u043c, \u043a\u043e\u0442\u043e\u0440\u043e\u0435 \u0432\u044b\u0432\u043e\u0434\u0438\u0442\u0441\u044f \u0447\u0435\u0440\u0435\u0437 \u043f\u043e\u0447\u043a\u0438.<\/p>\n<p>\u0423\u0440\u043e\u0432\u0435\u043d\u044c \u0430\u043c\u043c\u0438\u0430\u043a\u0430 \u043f\u043e\u0432\u044b\u0448\u0430\u0435\u0442\u0441\u044f, \u0435\u0441\u043b\u0438 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