Healthcare in Sri Lanka is primarily delivered free of charge by the government. However, certain laboratory services remain underdeveloped. For instance, blood ammonia testing is currently available in only one or two hospitals across the country. Despite being the third-largest hospital in Sri Lanka, with a bed strength exceeding 2,000, the National Hospital in Galle (NHG) had not previously established the facility for blood ammonia testing.

As a result, serum samples had to be separated and transported on ice to the Lady Ridgeway Hospital in Colombo, located approximately two hours from NHG. Unfortunately, due to transportation delays and handling issues, many of the results were falsely elevated. Although multiple discussions were held with the hospital’s chemical pathologist to acquire an ammonia analyser, these efforts were not successful.

Exploring the Use of a Point-of-Care Ammonia Analyser

While seeking alternative solutions, I had the opportunity to meet Professor Stefan Kölker during the Early Diagnosis and Early Treatment of Inherited Metabolic Disorders workshop organised by the Recordati Foundation in Tokyo in 2023. Professor Kölker suggested the use of point-of-care (POC) ammonia analysers in resource-limited settings, which sparked the idea of implementing this technology at NHG.

Think Ammonia – Sri Lanka

Around the same time, I became involved in the “Think Ammonia” programme through collaboration with Metabolic Support UK. Recognising the urgent need for accessible ammonia testing, I pursued options for acquiring a POC analyser through donations.

Selection of the Ammonia Analyser

Following extensive discussions with several suppliers, we selected the PocketChem BA PA-4140 Blood Ammonia Meter as the most suitable option for our setting.
https://www.woodleyequipment.com/product/474/PocketChem-BA-Blood-Ammonia-Analyser

Funding Support

The analyser, along with reagents sufficient for one year of testing, was generously donated by the Sri Lankan Association of Oregon. Dr Kalana Jayawardana played a key role in coordinating and facilitating this project.

Outcome

Over the past five months, a total of nine blood ammonia tests have been performed using the point-of-care analyser. Among these, one case of hyperammonaemia was detected, with an ammonia level of 120 µmol/L. Further investigations led to the diagnosis of Abernethy malformation in this patient.

Limitations

While the analyser can measure ammonia levels up to a maximum of 285 µmol/L, it may not be ideal for detecting extremely high values. Nevertheless, in the absence of any other readily available method, it serves as a valuable tool to initiate timely management of hyperammonaemia.

Recommendations

Point-of-care (POC) ammonia analysers represent a valuable tool for the early detection of hyperammonaemia, especially in resource-limited settings where conventional laboratory testing is not readily available. Their timely use can significantly improve patient outcomes by enabling earlier diagnosis and intervention.