Objective: To assess the correlation between serum ammonia levels with the severity of Hepatic Encephalopathy (HE) in patients visiting to the tertiary care hospital with advance liver disease. Methodology: This is a Descriptive, analytical study conducted at Jinnah Hospital Lahore from May 2019 to November 2019. A total of 50 patients with liver cirrhosis and HE had serum ammonia levels checked at presentation of patient. The diagnosis of HE was constructed on clinical criteria, and its

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... y was graded according to the "West Haven Criteria for grading of mental status". Ammonia levels were correlated with the severity of HE using Spearman rank correlation. Results: Out of 15 patients with normal ammonia levels, 8 (53.3%) were in hepatic encephalopathy grade I and II, 5 (33%) were in grade-III, while 2 (13.33%) patient were in grade-IV hepatic encephalopathy. Out of 22 patients with mildly raised ammonia levels, 6 (27.27%) were having grade I-II encephalopathy, 4 (18.18%) were in grade-III and 12 (54.54%) were having grade-IV HE. Out of 4 patients with moderate hyperammonemia, 1 (25%) was in grade II, 2 (50%) were in grade-III, and 1 (25%) were in grade-IV HE. Out of 9 patients with severe hyperammonemia, 6 (66.67%) patients were in grade-IV. Conclusion: Serum ammonia levels correlated with the severity of hepatic encephalopathy. Increased ammonia level, severe is the grade of hepatic encephalopathy. Key Words: Ammonia. Hepatic encephalopathy. Cirrhosis. Hyperammonemia.