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Related Experiment Videos

Acute hyperammonemic coma with chronic valproic acid therapy.

Miroslav Cuturic1, Ruth K Abramson

  • 1Division of Neurology, Department of Neuropsychiatry and Behavioral Science, School of Medicine, University of South Carolina, Columbia, 29203, USA. mirocuturic@yahoo.com

The Annals of Pharmacotherapy
|November 17, 2005
PubMed
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A rare case of valproic acid-induced hyperammonemic coma without liver failure occurred in a patient with epilepsy. This highlights the need for vigilance regarding this severe adverse effect, even with long-term valproate therapy.

Area of Science:

  • Neurology
  • Clinical Pharmacology
  • Biochemistry

Background:

  • Valproic acid is a widely used antiepileptic drug.
  • Hyperammonemic coma is a rare but serious adverse effect associated with valproate therapy.
  • This complication is typically seen in patients with inborn errors of metabolism or during initial treatment phases.

Observation:

  • A 56-year-old woman with epilepsy on chronic valproate therapy experienced hyperammonemic coma after a dose increase.
  • The patient had received subtherapeutic valproate levels for six years prior to the event.
  • No evidence of liver failure was present.

Findings:

  • The case suggests a dose-related hyperammonemic coma linked to valproic acid.
  • A family history hinted at a possible X-linked urea cycle enzyme deficiency, potentially unmasked by valproate.

Related Experiment Videos

  • The Naranjo scale indicated a probable causal relationship between valproic acid and the coma.

    • Implications:

    • Clinicians should maintain a high suspicion for hyperammonemic coma as a potential adverse effect of valproate, irrespective of treatment duration.
    • This rare complication underscores the importance of monitoring ammonia levels, especially in patients with risk factors.
    • Early recognition and management are crucial for preventing potentially fatal outcomes.