Valproate induced hyperammonemic encephalopathy treated by haemodialysis

Area of Science:

• Neurology
• Toxicology
• Pharmacology

Background:

• Divalproex sodium (DVPX) is a widely used antiepileptic and mood-stabilizing drug.
• Valproate (VPA) is the active metabolite of DVPX.
• Hyperammonemic encephalopathy is a rare but severe adverse effect associated with VPA treatment.

Observation:

• The patient presented with altered mental status, drowsiness, lethargy, and coma after initiating DVPX therapy.
• Serum ammonia levels were significantly elevated despite therapeutic VPA levels.
• Liver function tests were normal, ruling out hepatic encephalopathy as the primary cause.

Findings:

• The clinical presentation and laboratory findings were consistent with VPA-induced hyperammonemic encephalopathy.
• The patient's condition improved with discontinuation of DVPX, hemodialysis, and supportive care.
• This case highlights the importance of monitoring ammonia levels in patients treated with DVPX.

Implications:

• Early recognition and management of VPA-induced hyperammonemic encephalopathy are critical to prevent severe neurological complications.
• Discontinuation of DVPX is the primary treatment strategy.
• This adverse effect underscores the need for vigilant patient monitoring during DVPX therapy.