Valproate Induced Hyperammonemic Delirium

Area of Science:

• Neuroscience
• Clinical Pharmacology
• Psychiatry

Background:

• Sodium valproate is a widely used antiepileptic and mood-stabilizing drug.
• Hyperammonaemic delirium is a rare but serious adverse effect of valproate therapy.
• This condition can be misdiagnosed as worsening psychiatric symptoms.

Purpose of the Study:

• To report a case series of hyperammonaemic delirium induced by sodium valproate.
• To highlight the importance of recognizing this uncommon adverse effect.
• To emphasize the need for monitoring plasma ammonia levels in patients on valproate.

Main Methods:

• A retrospective case series analysis.
• Data collected from patients reported to the Department of Pharmacology from the Department of Psychiatry over one year.
• Review of clinical presentation, diagnosis, and management.

Main Results:

• Identified cases of hyperammonaemic delirium in patients treated with sodium valproate.
• Observed that liver function tests were normal in these patients.
• Confirmed that the condition can mimic psychosis or mania.

Conclusions:

• Hyperammonaemic delirium is an important differential diagnosis in patients on valproate presenting with altered mental status.
• Normal liver function tests do not exclude valproate-induced hyperammonaemia.
• Regular monitoring of plasma ammonia levels is recommended for patients receiving valproate therapy.