**Question:** Which one of the following is a symptom of ammonia intoxication?

A. Confusion
B. Coma
C. Drowsiness
D. Flushing

**Correct Answer:** **B. Coma**

**Core Concept:** Ammonia intoxication is a significant health issue, particularly in liver disease patients, as it is a consequence of impaired ammonia detoxification.

**Why the Correct Answer is Right:** Ammonia, a product of cellular breakdown of proteins, is detoxified in the liver through a series of enzymatic reactions, mainly via the urea cycle. In liver disease, this cycle is impaired, leading to increased ammonia levels in the bloodstream. Elevated ammonia levels cause the brain to be exposed to toxic concentrations, leading to neurological complications. Coma is a severe stage of ammonia intoxication, as it represents a severe impairment of brain function due to ammonia toxicity.

**Why Each Wrong Option is Incorrect:**

**A. Confusion:** While confusion is a symptom of ammonia intoxication, it is not as severe as coma. Confusion is an early manifestation of ammonia toxicity, while coma is a later, more severe stage.

**C. Drowsiness:** Similar to confusion, drowsiness is an early symptom of ammonia toxicity. However, it is less severe than confusion and does not necessarily progress to coma.

**D. Flushing:** Flushing is an unrelated symptom and is not associated with ammonia intoxication. It is a manifestation in cases like neurogenic blushing or vasodilation, which are unrelated to ammonia toxicity.

**Clinical Pearl:** Ammonia intoxication is a result of impaired liver function, as the liver plays a vital role in detoxifying ammonia. Early symptoms include confusion and drowsiness, followed by more severe symptoms such as coma, which may lead to neurological impairment and even death if not treated promptly.