Hyperammonemia impairs Citric acid cycle by depleting

Hyperammonemia, as occurs in advanced liver disease, leads to loss of consciousness, coma, and convulsions as a result of the impaired activity of the citric acid cycle, leading to reduced formation of ATP. Ammonia both depletes citric acid cycle intermediates (by withdrawing a-ketoglutarate for the formation of glutamate and glutamine) and also inhibits the oxidative decarboxylation of a-ketoglutarate. Reference: Harper; 30th edition; Page no: 161