Ozen Sakir, Bülbül Israfil, Soyuçok Etem
Turk Psikiyatri Derg. 2010 Spring;21(1):79-84.
Delirium may present with hyperactive, hypoactive or mixed clinical pictures. The signs of hypoactive delirium are lethargy, confusion, apathy, hypersomnia, muttering, difficulty in maintaining attention, and difficulty in understanding and performing commands. Valproate is commonly used for the treatment of epilepsy and bipolar disorders. It is also used for the management of alcohol withdrawal delirium and agitative-aggressive deliriums. However, few reports are available about the valproate-induced delirium. In this report, we present a 46 years-old woman with bipolar disorder for 14 years. During her last two hospital admissions, she had been diagnosed with manic episode with psychotic features and she had received valproate. She experienced three hypoactive delirium episodes lasting 2-3 days throughout the treatment period of first week. The patient predominantly had the following signs; vomiting, hypersalivation, confusion, drowsiness, dysphasia, and hypoactivity. At the first day of delirium episode, serum valproate level was found to be within the therapeutic range (98.4, 117.1, and 65.6 mug/ml; respectively). In addition, she had normal results of cranial MRI, complete blood count, urine analysis, electrocardiogram, ALT, AST, albumin, bilirubin, BUN, creatinine and electrolytes. The serum ammonia level of the patient could not been measured due to limitations of laboratory facilities. The patient's consciousness improved dramatically 2-3 days after cessation of valproate. In conclusion, valproate can induce delirium at therapeutic blood levels in some patients via various mechanisms and this side effect has to be considered during valproate use.
谵妄可能表现为多动、少动或混合性临床表现。少动型谵妄的体征包括嗜睡、意识模糊、冷漠、嗜睡、喃喃自语、难以保持注意力以及难以理解和执行指令。丙戊酸盐常用于治疗癫痫和双相情感障碍。它也用于管理酒精戒断谵妄和激越性谵妄。然而，关于丙戊酸盐所致谵妄的报道很少。在本报告中，我们介绍了一位患有双相情感障碍14年的46岁女性。在她最近两次住院期间，她被诊断为伴有精神病性特征的躁狂发作，并接受了丙戊酸盐治疗。在第一周的整个治疗期间，她经历了三次少动型谵妄发作，持续2 - 3天。患者主要有以下体征：呕吐、流涎过多、意识模糊、嗜睡、言语困难和活动减少。在谵妄发作的第一天，发现血清丙戊酸盐水平在治疗范围内（分别为98.4、117.1和65.6μg/ml）。此外，她的头颅MRI、全血细胞计数、尿液分析、心电图、谷丙转氨酶、谷草转氨酶、白蛋白、胆红素、血尿素氮、肌酐和电解质检查结果均正常。由于实验室设备的限制，患者的血清氨水平无法测量。停用丙戊酸盐2 - 3天后，患者的意识显著改善。总之，丙戊酸盐可通过多种机制在某些患者的治疗血药浓度水平下诱发谵妄，在使用丙戊酸盐时必须考虑到这种副作用。
