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Valproic acid rechallenge after valproate-induced hyperammonemic encephalopathy
Farhan Mithani1,2, Stav Cullum1,2, Ranjit Chacko2
1College of Medicine, Texas A&M Health Science CenterBryanTexas.
Proceedings (Baylor University. Medical Center)
|July 18, 2020
Summary
Valproic acid (VPA) can cause hyperammonemic encephalopathy (VIHE). This case shows successful VPA rechallenge without supplementation in managing VIHE, highlighting treatment challenges.
Area of Science:
- Neuroscience
- Psychiatry
- Clinical Pharmacology
Background:
- Valproic acid (VPA) is frequently used for behavioral disturbances.
- Valproate-induced hyperammonemic encephalopathy (VIHE) is a potential adverse effect of VPA treatment.
- Managing VIHE presents clinical challenges, especially in patients requiring long-term VPA therapy.
Observation:
- A 24-year-old male with traumatic brain injury experienced acute agitation and aggression.
- The patient developed VIHE, characterized by lethargy, confusion, delirium, and ataxia, after VPA treatment.
- Elevated serum ammonia levels (96 μmol/L) were noted during the VIHE episode.
Findings:
- Current guidelines suggest VPA discontinuation or rechallenge with supplementation for VIHE.
- This case report details a successful VPA rechallenge without supplementation to manage VIHE.
- A lower VPA dose with gradual up-titration normalized ammonia levels and improved clinical symptoms.
Implications:
- This case demonstrates a viable strategy for managing VIHE in noncompliant patients.
- Further research is needed to optimize VIHE prevention and management strategies.
- Understanding VIHE is crucial for safe and effective VPA use in clinical practice.
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