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DefinitionHepatic encephalopathy is a reversible neurologic syndrome that results from advanced liver dysfunction or portosystemic shunting. It leads to disturbances in cognition, behavior, and motor function due to the brain’s exposure to gut-derived toxins that the liver fails to detoxify.EtiologyThis condition develops either in the setting of acute fulminant hepatitis or progressively during chronic liver disease, such as cirrhosis and portal hypertension. Portosystemic...

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Related Experiment Video

Updated: May 1, 2026

Microdialysis of Excitatory Amino Acids During EEG Recordings in Freely Moving Rats

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Published on: November 8, 2018

Sodium valproate-related hyperammonaemic encephalopathy.

Emily Jane Pegg¹, Fawad Zaman

¹Lancashire Teaching Hospitals, Preston, Lancashire, UK.

BMJ Case Reports

|April 12, 2014

Summary

Valproate-related hyperammonaemic encephalopathy can cause confusion in patients, even with normal liver tests. Prompt diagnosis and switching antiepileptic drugs can resolve symptoms.

Area of Science:

Neurology
Toxicology

Background:

Epilepsy management often involves sodium valproate.
Patient presented with acute confusion and altered consciousness.

Observation:

Despite normal routine blood tests, thyroid function, serum valproate levels, urine dip, brain CT, and CSF analysis, EEG showed encephalopathy.
Elevated serum ammonia levels were detected.

Findings:

The patient was diagnosed with valproate-related hyperammonaemic encephalopathy.
Changing the antiepileptic medication led to gradual resolution of confusion.

Implications:

Valproate-related hyperammonaemic encephalopathy is a critical, treatable diagnosis in patients on sodium valproate presenting with confusion.

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Consider this diagnosis even with normal liver function tests and therapeutic drug levels.