Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN 55905, USA.
Gen Hosp Psychiatry. 2012 May-Jun;34(3):290-8. doi: 10.1016/j.genhosppsych.2011.12.009. Epub 2012 Feb 2.
Valproate (VPA)-induced hyperammonemic encephalopathy (VHE) is a serious drug-related adverse effect characterized by lethargy, vomiting, cognitive slowing, focal neurological deficits and decreased levels of consciousness ranging from drowsiness to coma.
We present a case series (n=5) and also review previous cases of VHE (n=30) in psychiatric patients to provide an update on risk factors, clinical correlates and management of VHE.
To our knowledge, there are 30 (16 female, 14 male) previously reported VHE cases in psychiatric patients. Risk factors for VHE include VPA-drug interactions, mental retardation, carnitine deficiency and presence of urea cycle disorders. Length of VPA treatment, VPA dosage, serum VPA levels and serum ammonia levels do not appear to correlate with onset or severity of VHE.VPA discontinuation is the primary treatment of VHE, although, l-carnitine, lactulose and neomycin have been used adjunctively in some patients.
Clinicians should consider VHE in patients taking VPA who present with lethargy, gastrointestinal symptoms, confusion and decreased levels of drowsiness. VPA discontinuation is currently the mainstay of treatment for VHE, although more research is warranted to delineate the underlying risk factors for VHE and consolidate treatment modalities for this potentially life-threatening drug adverse effect.
丙戊酸（VPA）诱导的高氨血症性脑病（VHE）是一种严重的药物相关不良反应，其特征为嗜睡、呕吐、认知迟缓、局灶性神经功能缺损和意识水平下降，从嗜睡到昏迷不等。
我们报告了一系列病例（n=5），并回顾了之前精神病患者的 30 例 VHE 病例（n=30），以提供 VHE 的风险因素、临床相关性和管理的最新信息。
据我们所知，目前有 30 例（16 名女性，14 名男性）先前报道的精神病患者 VHE 病例。VHE 的风险因素包括 VPA-药物相互作用、智力障碍、肉碱缺乏症和尿素循环障碍的存在。VPA 治疗的时间、VPA 剂量、血清 VPA 水平和血清氨水平似乎与 VHE 的发作或严重程度无关。VPA 停药是 VHE 的主要治疗方法，尽管在一些患者中，左旋肉碱、乳果糖和新霉素被联合使用。
当服用 VPA 的患者出现嗜睡、胃肠道症状、意识混乱和嗜睡程度下降时，临床医生应考虑 VHE。VPA 停药目前是 VHE 的主要治疗方法，尽管需要更多的研究来阐明 VHE 的潜在风险因素，并整合这种潜在威胁生命的药物不良反应的治疗方法。
