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Related Experiment Videos

Hyperammonemia and coma without hepatic dysfunction induced by valproate therapy.

F Barrueto1, J B Hack

  • 1Pitt County Memorial Hospital, Brody School of Medicine, East Carolina University, Greenville, NC, USA. fbarrueto@hotmail.com

Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine
|October 3, 2001
PubMed
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A patient with bipolar disorder developed severe hyperammonemia and coma due to valproate therapy, despite normal liver function. This case highlights a rare but serious side effect of valproic acid treatment.

Area of Science:

  • Neurology
  • Clinical Toxicology

Background:

  • Valproic acid is a widely used antiepileptic and mood-stabilizing drug.
  • Hyperammonemia is a known, albeit uncommon, side effect of valproic acid therapy.

Observation:

  • A 41-year-old male with bipolar disorder presented with altered mental status and was found to have markedly elevated ammonia levels (377 microM/L).
  • The patient exhibited no signs of hepatic insufficiency or other contributing metabolic abnormalities.
  • The hyperammonemia and coma were directly linked to chronic, therapeutic valproate use.

Findings:

  • This case represents the highest reported serum ammonia level associated with therapeutic valproate levels in the absence of confounding factors.
  • The findings underscore the potential for severe hyperammonemia even with normal liver function in patients on valproic acid.

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Implications:

  • Clinicians should consider monitoring ammonia levels in patients experiencing altered mental status while on valproate therapy.
  • Early recognition and potential intervention with agents like L-carnitine may be crucial for managing valproate-induced hyperammonemia.