Chauhan Vinay Singh, Dixit Siddarth, Goyal Sunil, Azad Sudip
Department of Psychiatry, Base Hospital Delhi Cantonment, Delhi Cantonment, New Delhi, India.
Department of Psychiatry, Command Hospital, Pune, Maharashtra, India.
Ind Psychiatry J. 2017 Jan-Jun;26(1):99-102. doi: 10.4103/ipj.ipj_37_16.
Valproate (VPA)-induced hyperammonemic encephalopathy is an unusual, but serious, adverse effect of divalproex sodium (DVPX) treatment and if untreated can lead to raised intracranial pressure, seizures, coma, and eventually death. It can, however, be reversed if an early diagnosis is made. It is therefore extremely important to recognize it and discontinue DVPX treatment. Our patient developed sudden deterioration of sensorium, drowsiness, lethargy, and later severe comatose state after few days of starting DVPX with high levels of serum ammonia despite therapeutic levels of VPA and normal liver function test. He responded to hemodialysis, cerebral decongestants, and other intensive supportive measures.
丙戊酸盐（VPA）诱发的高氨血症性脑病是双丙戊酸钠（DVPX）治疗一种不常见但严重的不良反应，若不治疗可导致颅内压升高、癫痫发作、昏迷，并最终死亡。然而，如果能早期诊断，它是可以逆转的。因此，识别并停用DVPX治疗极为重要。我们的患者在开始使用DVPX几天后出现意识突然恶化、嗜睡、昏睡，随后出现严重昏迷状态，尽管VPA处于治疗水平且肝功能检查正常，但血清氨水平很高。他对血液透析、脑减压药及其他强化支持措施有反应。
