Data from 23 normal men and women were used to derive 95% confidence limits for maximum changes in ammonia and lactate values following ischemic forearm exercise. Most normal subjects raised serum lactate and ammonia concentrations more than 20 mg/dl and 100 micrograms/dl, respectively, over baseline values. No significant correlations were found among age, sex, duration of exercise, or estimate of work performed and the maximum ammonia and lactate values achieved. When 70 patients with complaints of weakness, fatigue, or cramps were evaluated, the ischemic exercise test identified 5 patients who proved to have defects in glycolysis or purine metabolism. The test also distinguished those patients with type III glycogen storage disease who lacked debrancher enzyme activity in muscle.