Gayam Vijay, Mandal Amrendra Kumar, Khalid Mazin, Shrestha Binav, Garlapati Pavani, Khalid Mowyad
Department of Medicine, Interfaith Medical Center, Brooklyn, NY, USA.
Department of Medicine, Wayne State University/Detroit Medical center, Detroit, MI, USA.
J Community Hosp Intern Med Perspect. 2018 Oct 15;8(5):311-314. doi: 10.1080/20009666.2018.1514933. eCollection 2018.
Valproic acid (VPA) is a commonly used agent in the management of seizures and psychiatric disorders. Hyperammonemia is a common complication of VPA with 27.8% of patients having elevated levels - that is unrelated to hepatotoxicity and normal transaminases. Common side effects include obesity, insulin resistance, metabolic disorder and severe forms of hepatotoxicity. Other rare and idiosyncratic reactions have been reported, one of which is presented in our case. A 27-year old patient presented with hyperammonemia and encephalopathy as a consequence of idiosyncratic VPA reaction causing drug-induced liver injury (DILI) with severely elevated transaminases. DILI is commonly overlooked when investigating encephalopathy in the setting of VPA. Physicians should consider DILI in the context of hyperammonemia and transaminitis.
丙戊酸（VPA）是治疗癫痫和精神疾病的常用药物。高氨血症是VPA常见的并发症，27.8%的患者血氨水平升高，这与肝毒性和转氨酶正常无关。常见副作用包括肥胖、胰岛素抵抗、代谢紊乱和严重的肝毒性。还报告了其他罕见的特异反应，本文病例即为其中之一。一名27岁患者因VPA特异反应导致药物性肝损伤（DILI），转氨酶严重升高，出现了高氨血症和脑病。在VPA导致的脑病调查中，DILI常被忽视。医生应在高氨血症和转氨酶升高的背景下考虑DILI。
