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Early physical symptoms of elevated blood ammonia include fatigue, muscle weakness, loss of appetite, nausea, vomiting, diarrhea, pain in the back, sides or abdomen, or other symptoms of liver and kidney damage.
1 The urine tends to be concentrated and have a strong smell of ammonia when an individual fails to take in sufficient amounts of water.  Liver damage - This may also cause an ammonia smell in urine, because the liver is responsible for removing and breaking down ammonia.