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Valproate-Induced Hyperammonemic Encephalopathy in General Hospital Patients With One or More Psychiatric Disorders
Chandani Lewis1, George E Tesar1, Roman Dale1
1Department of Psychiatry and Psychology, Neurological Institute, Cleveland Clinic, Cleveland, OH.
Psychosomatics
|April 17, 2017
Summary
Valproate-induced hyperammonemic encephalopathy (VHE) may be more common in psychiatric patients than previously thought. Early recognition and treatment are crucial for favorable outcomes in VHE.
Area of Science:
- Neurology
- Pharmacology
- Psychiatry
Background:
- Divalproex sodium/valproic acid (VPA) is an antiepileptic drug used for epilepsy and bipolar disorder.
- Valproate-induced hyperammonemia (VIH) affects up to 50% of VPA-treated patients, potentially leading to encephalopathy.
- Valproate-induced hyperammonemic encephalopathy (VHE) is considered rare and challenging to diagnose, requiring a high index of suspicion.
Purpose of the Study:
- To determine the prevalence of VHE in psychiatric patients.
- To assess the quality of VHE diagnosis and treatment.
Main Methods:
- Retrospective, cross-sectional survey of general hospital patients.
- Combined laboratory and pharmacy databases to identify VPA-treated patients with hyperammonemia over 5 years.
- Reviewed hospital records of patients with psychiatric disorders for data collection.
Main Results:
- 2.52% (20 of 793) of VPA-treated patients exhibited symptoms consistent with VHE.
- The majority of affected patients were White males on multiple psychotropic agents.
- Valproate was discontinued in 40% of cases; lactulose was the only ammonia-lowering agent used in 6 patients, with VPA discontinued in only one.
Conclusions:
- VHE may be more prevalent in psychiatric patients than previously assumed.
- VHE is often underrecognized and inadequately treated.
- Prompt diagnosis and appropriate treatment lead to favorable outcomes.