Deutsch Stephen I, Burket Jessica A, Rosse Richard B
Mental Health Service Line, Department of Veterans Affairs Medical Center, 50 Irving Street NW, Washington, DC 20422, USA.
Clin Neuropharmacol. 2009 Nov-Dec;32(6):350-2. doi: 10.1097/WNF.0b013e3181ac3615.
A patient with valproate-induced hyperammonemic encephalopathy presented with altered mental status and hyperammonemia in the context of normal liver functions. Fortunately, altered mental status and elevated plasma ammonia level normalized 1 day after discontinuation of divalproex sodium (Depakote). The case analysis suggests a possible synergistic interaction of valproic acid and topiramate with respect to the emergence of hyperammonemic encephalopathy in the context of normal liver functions. Possible mechanisms of the encephalopathy and hyperammonemia are discussed. For example, valproate has diverse metabolic effects that include regulating levels of ammonia by altering activity of the urea cycle, whose first step uses HCO3 in the synthesis of carbamoylphosphate. Topiramate's inhibition of carbonic anhydrase activity may be the basis of its possible synergy with valproate by affecting levels of HCO3.
一名患有丙戊酸盐诱导的高氨血症性脑病的患者，在肝功能正常的情况下出现精神状态改变和高氨血症。幸运的是，停用双丙戊酸钠（德巴金）1天后，精神状态改变和血浆氨水平升高恢复正常。病例分析表明，在肝功能正常的情况下，丙戊酸和托吡酯在高氨血症性脑病的发生方面可能存在协同相互作用。文中讨论了脑病和高氨血症的可能机制。例如，丙戊酸盐具有多种代谢作用，包括通过改变尿素循环的活性来调节氨水平，尿素循环的第一步在合成氨甲酰磷酸时使用HCO3。托吡酯对碳酸酐酶活性的抑制可能是其与丙戊酸盐可能产生协同作用的基础，因为它会影响HCO3的水平。
