Severe valproate induced hyperammonemic encephalopathy successfully managed with peritoneal dialysis

Area of Science:

• Neurology
• Nephrology

Background:

• Valproic acid (VPA) is a widely prescribed medication for epilepsy, psychiatric conditions, and migraines, often used in neurosurgical intensive care units.
• While generally safe, VPA can cause idiosyncratic side effects, including valproate-induced hyperammonemia (VIH).
• VIH can manifest as valproate-induced hyperammonemic encephalopathy (VHE), presenting neurological symptoms.

Observation:

• VHE typically resolves upon VPA discontinuation.
• However, some VHE cases are refractory to supportive care and can become life-threatening.
• This case involved a postoperative neurosurgical patient experiencing severe, life-threatening VHE.

Findings:

• The patient presented with severe hyperammonemic encephalopathy secondary to VPA use.
• Standard supportive measures were insufficient to manage the life-threatening hyperammonemia and encephalopathy.
• Peritoneal dialysis was initiated as a critical intervention.

Implications:

• Peritoneal dialysis rapidly reversed hyperammonemia and VHE in this critical case.
• Dialysis can be a life-saving measure for severe, refractory VHE.
• This highlights the importance of considering dialysis in managing severe VPA-induced hyperammonemic encephalopathy, particularly in neurosurgical patients.