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Valproic Acid Induced Hyperammonemia in a Long Time Treated Patient.

Rohit Aiyer1, Margaret Seide1, Robert G Stern1

  • 1Hofstra Northwell School of Medicine, Staten Island University Hospital, Staten Island, NY 10305, USA.

Case Reports in Psychiatry
|August 13, 2016
PubMed
Summary

Chronic valproic acid use can cause asymptomatic hyperammonemia. Treatment with carnitine and lactulose is effective, and valproic acid need not be stopped if the patient shows no signs of encephalopathy.

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Area of Science:

  • Neuroscience
  • Pharmacology

Background:

  • Valproic acid is a common treatment for bipolar affective disorder.
  • Hyperammonemia is a potential side effect of valproic acid therapy.

Purpose of the Study:

  • To report a case of asymptomatic hyperammonemia in a patient on long-term valproic acid.
  • To discuss the management of hyperammonemia in this context.

Main Methods:

  • A case study of a patient with bipolar disorder on chronic valproic acid.
  • Monitoring of serum ammonia levels.
  • Treatment with carnitine and lactulose while continuing valproic acid.

Main Results:

  • The patient presented with markedly elevated ammonia levels but remained asymptomatic.
  • Dual therapy with carnitine and lactulose effectively reduced ammonia levels.
  • Valproic acid was continued throughout the treatment without dose adjustment.

Conclusions:

  • Asymptomatic hyperammonemia can occur with chronic valproic acid use.
  • Discontinuation of valproic acid is not always necessary for elevated ammonia levels if the patient is asymptomatic.
  • Carnitine and lactulose are potential treatment options for valproic acid-induced hyperammonemia.