What Happens When You Have Too Much Nitrogen In Your Body? A Medical Guide

While nitrogen is a vital component of proteins and nucleic acids, an excess can be toxic. Knowing what happens when you have too much nitrogen in your body is crucial, as it can lead to serious health issues impacting the nervous system, kidneys, and liver.

Quick Summary

An excess of nitrogen in the body can result from several distinct causes, leading to serious medical conditions ranging from the metabolic waste buildup of uremia to the pressure-induced hazards of decompression sickness in divers.

Key Points

• Two Forms of Toxicity: Excess nitrogen can cause harm through metabolic waste (uremia, hyperammonemia) or environmental exposure (decompression sickness, nitrogen narcosis).

• Kidney and Liver Strain: The liver and kidneys are the primary organs for processing and excreting nitrogenous waste; overload can cause significant and potentially permanent damage.

• Neurological Impact: Both hyperammonemia and nitrogen narcosis can cause neurological symptoms like confusion, memory loss, and seizures, due to their toxic effects on the brain.

• Diver's Risk: Scuba diving can expose individuals to pressurized nitrogen, risking temporary narcosis at depth and dangerous bubble formation (DCS) upon rapid ascent.

• Treatment Varies: There is no single treatment for excess nitrogen; the approach depends on the underlying cause, ranging from medical dialysis and medication to controlled recompression therapy.

• Dietary Control is Key: For metabolic nitrogen issues, managing dietary protein intake can reduce the strain on the body's detoxification organs.

The Different Forms of Nitrogen Toxicity

Understanding the health risks associated with excess nitrogen requires distinguishing between its various forms. The most common forms arise from either metabolic overproduction of nitrogenous waste or environmental exposure to pressurized nitrogen gas.

Metabolic Nitrogen Overload: Uremia and Hyperammonemia

In normal metabolism, the body processes excess protein and amino acids. The nitrogen from these compounds is converted into ammonia, which is then transformed into less toxic urea by the liver through a process called the urea cycle. The kidneys are responsible for filtering this urea from the blood for excretion in the urine.

When this delicate balance is disrupted, a cascade of health problems can occur. Two primary conditions related to metabolic nitrogen waste are uremia and hyperammonemia.

• Uremia: This condition occurs when the kidneys fail to adequately filter urea from the blood, causing waste products to build up to toxic levels. It is often a complication of kidney failure. Symptoms are a direct result of this internal poisoning and can affect multiple body systems.
• Hyperammonemia: This is a rarer but extremely dangerous condition characterized by an excess of ammonia in the blood. Since ammonia is a potent neurotoxin, high levels are particularly harmful to the brain. Hyperammonemia is most often seen with severe liver disease, as the liver can no longer effectively perform the urea cycle to detoxify the ammonia.

Symptoms of Metabolic Nitrogen Overload

Early recognition of these conditions is critical for prompt treatment. Symptoms can range from general malaise to severe neurological and systemic issues. For uremia, signs often reflect worsening kidney function:

• Confusion and disorientation
• Fatigue and general weakness
• Decreased urine output
• Edema (swelling) in the extremities
• Dry mouth and excessive thirst

Hyperammonemia, due to its neurotoxic nature, primarily causes neurological symptoms:

• Altered mental status and confusion
• Lethargy and sleep pattern changes
• Slurred speech and unsteady gait
• Seizures or tremors
• In severe cases, coma and brain swelling can occur

Environmental Exposure: Decompression Sickness and Nitrogen Narcosis

Excess nitrogen can also pose a threat through environmental factors, most notably in scuba diving. These conditions are not related to metabolic waste but to the inert nitrogen gas that makes up nearly 78% of the air we breathe.

• Nitrogen Narcosis: This state occurs during deep dives, when the high partial pressure of nitrogen gas in the blood and tissues begins to exert a narcotic effect on the central nervous system. It can impair judgment, memory, and concentration, causing a feeling of euphoria or confusion often compared to being drunk. Fortunately, the effects are temporary and resolve upon ascending to a shallower depth.
• Decompression Sickness (DCS): More commonly known as “the bends,” DCS is a serious condition caused by nitrogen bubbles forming in the bloodstream and tissues. It occurs when a diver ascends too quickly, causing the dissolved nitrogen gas to come out of solution rapidly, much like a shaken soda bottle being opened. The bubbles can block blood flow and cause severe pain, paralysis, joint damage, or even death.

A Comparative Look at Excess Nitrogen Conditions

Feature	Uremia	Hyperammonemia	Decompression Sickness	Nitrogen Narcosis
Cause	Kidney failure leads to metabolic waste buildup	Liver failure or metabolic defect causes ammonia buildup	Rapid ascent from deep diving	Deep diving pressure
Nitrogen Form	Urea (nitrogenous waste)	Ammonia (neurotoxin)	Inert nitrogen gas bubbles	Inert nitrogen gas dissolved in blood/fat tissue
Primary System Affected	Kidneys, multiple organs	Brain, central nervous system	Joints, nervous system, lungs	Brain, central nervous system
Symptoms	Fatigue, confusion, swelling, low urine	Confusion, seizures, lethargy, coma	Joint pain, rash, paralysis, stroke	Impaired judgment, euphoria, memory loss
Treatment	Dialysis, managing underlying kidney issue	Dialysis, medications, managing liver disease	Hyperbaric oxygen therapy	Ascend to shallower depth

Management and Prevention

Prevention and treatment for excess nitrogen depend entirely on the underlying cause. Strategies can vary dramatically, from dietary changes to emergency recompression.

Strategies for Metabolic Nitrogen Control

1. Manage Underlying Conditions: The most important step for both uremia and hyperammonemia is to treat the root cause, typically kidney or liver disease.
2. Adjust Protein Intake: Since dietary protein is the main source of nitrogen, a doctor or registered dietitian may recommend a lower protein diet to reduce the burden on the liver and kidneys.
3. Stay Hydrated: Proper hydration is essential for kidney function and helps flush nitrogenous waste from the body.
4. Medical Treatment: For severe cases, especially hyperammonemia, emergency medical intervention such as hemodialysis may be necessary to rapidly remove the toxins from the blood.

Strategies for Diving-Related Nitrogen Control

1. Follow Dive Tables and Computers: Always adhere to recommended depth and time limits provided by dive tables or a personal dive computer to prevent excess nitrogen absorption.
2. Perform Safety Stops: A slow, controlled ascent is crucial. Incorporating safety stops during ascent allows the body to release absorbed nitrogen gradually.
3. Avoid Flying After Diving: Wait the recommended time period (at least 12-18 hours) before flying, as the change in cabin pressure can trigger DCS.
4. Use Alternative Gas Mixes: For very deep dives, divers may use mixed gases containing helium instead of nitrogen to reduce the risk of narcosis and DCS.

The Role of the Liver and Kidneys

Maintaining nitrogen balance is one of the most critical functions of the liver and kidneys. The liver's role in converting toxic ammonia to urea and the kidneys' function in excreting that urea are essential for life. An increased workload from excess nitrogen, whether from a high-protein diet or disease, can put these organs under significant stress. Long-term stress can lead to chronic damage and further impair the body's ability to regulate nitrogen. For more detailed information on renal nitrogen metabolism, consult the authoritative research available through the National Institutes of Health.

Conclusion

Excess nitrogen in the body is not a single issue but a result of several distinct medical conditions, each with its own causes, symptoms, and treatments. From the life-threatening buildup of waste in uremia and hyperammonemia to the decompression-related risks in diving, understanding these differences is paramount. While some issues like nitrogen narcosis are transient, conditions affecting the liver and kidneys can be severely debilitating or fatal. Proper management of dietary protein, safe diving practices, and prompt medical intervention are crucial for preventing and treating the dangerous effects of excess nitrogen.

Frequently Asked Questions

What is the difference between nitrogen toxicity from protein and from diving?

Nitrogen toxicity from protein metabolism involves a buildup of nitrogenous waste products like urea and ammonia, which is often a sign of kidney or liver disease. Toxicity from diving is caused by inert nitrogen gas forming bubbles in the blood and tissues due to rapid changes in pressure.

What are the early signs of uremia?

Early signs of uremia, a buildup of nitrogen waste in the blood, can include fatigue, weakness, confusion, swelling (edema), and changes in urination. If you experience these symptoms, especially with existing kidney issues, seek medical advice.

How can I tell if a diver is experiencing nitrogen narcosis?

A diver experiencing nitrogen narcosis may show impaired judgment, disorientation, a false sense of euphoria, or memory loss. Their behavior might appear to be that of someone intoxicated. This is a temporary effect that disappears when the diver ascends to a shallower depth.

Is nitrogen overdose from breathing possible in a normal environment?

In a normal environment, the air is about 78% nitrogen, but this is not harmful. However, breathing pure nitrogen gas (or in a nitrogen-rich environment) can displace oxygen and cause asphyxiation, which is a significant workplace hazard, but it is not an internal overdose.

What organs are most affected by excess metabolic nitrogen?

The liver and kidneys are the most affected organs. The liver is responsible for converting toxic ammonia to urea, and the kidneys filter this urea from the blood. Damage to these organs impairs the body's ability to process and excrete nitrogenous waste.

Can diet help manage high nitrogen levels?

Yes, for metabolic nitrogen overload conditions like uremia, a doctor or dietitian may recommend a lower protein diet to reduce the amount of nitrogenous waste the body produces. This lessens the burden on the liver and kidneys.

What is the fastest way to treat high ammonia levels (hyperammonemia)?

Severe hyperammonemia is a medical emergency, particularly in cases of liver failure. Treatment often involves stopping protein intake, administering medications to reduce ammonia, and sometimes requiring hemodialysis to quickly remove toxins from the blood.