Elwadhi Deeksha, Prakash Rashmi, Gupta Manushree
Department of Psychiatry, HIMSR, Jamia Hamdard, New Delhi, India.
Department of Psychiatry, Lady Hardinge Medical College, New Delhi, India.
Indian J Psychol Med. 2017 Sep-Oct;39(5):668-670. doi: 10.4103/0253-7176.217033.
Valproate (VPA) is a well-tolerated and commonly used drug to treat variety of psychiatric and neurological disorders. VPA-induced hyperammonemic encephalopathy is a rare adverse effect which can commonly occur in the background of normal liver function and therapeutic serum levels. Any delay in treatment of VPA-induced hyperammonemic encephalopathy can lead to life-threatening coma thus a strong clinical suspicion, fair understanding of the pathophysiology, and management of this drug-related complication can prevent fatal outcome. We hereby report a series of cases admitted to a tertiary care center that developed hyperammonemia and all patients recovered on stopping VPA. This case series cautions the clinicians about hyperammonemia as an uncommon but highly plausible life-threatening side effect, emphasizing astute observation, and high degree of clinical suspicion to prevent mortality and limit morbidity. Early recognition of subtle gastrointestinal, cognitive, and behavioral signs can lead to immediate intervention with satisfying results.
丙戊酸盐（VPA）是一种耐受性良好且常用的药物，用于治疗多种精神和神经疾病。VPA诱发的高氨血症性脑病是一种罕见的不良反应，通常可在肝功能正常和血清治疗水平的情况下发生。VPA诱发的高氨血症性脑病治疗的任何延迟都可能导致危及生命的昏迷，因此强烈的临床怀疑、对病理生理学的充分理解以及对这种药物相关并发症的管理可以预防致命后果。我们在此报告一系列入住三级护理中心并发生高氨血症的病例，所有患者在停用VPA后均康复。该病例系列提醒临床医生注意高氨血症是一种罕见但极有可能危及生命的副作用，强调敏锐观察和高度的临床怀疑以预防死亡并限制发病。早期识别细微的胃肠道、认知和行为体征可导致立即干预并取得满意结果。
