McMorris Tressa, Chu Angela, Vu Lynn, Bernardini Amanda
Assistant Professor of Pharmacy Practice, College of Pharmacy, Roseman University of Health Sciences, South Jordan, Utah.
Pharmacist, CVS Pharmacy, Tuscon, Arizona; previously: Roseman University of Health Sciences College of Pharmacy.
Ment Health Clin. 2021 Jul 16;11(4):243-247. doi: 10.9740/mhc.2021.07.243. eCollection 2021 Jul.
Valproic acid (VPA) is widely used for the treatment of epilepsy, migraine, and a variety of psychiatric conditions. The reported incidences of hyperammonemia induced by VPA use is variable. The purpose of this study is to evaluate the incidence of VPA-induced hyperammonemia in the general adult inpatient population.
Adult patients who received at least 1 dose of VPA and derivatives between June 1, 2017 to December 31, 2017 were included. Patients were excluded if they did not have VPA administered during their inpatient stay or if they had elevated ammonia levels (>33 μmol/L) prior to initiation of VPA. Patients with a confirmed diagnosis of liver cirrhosis were also excluded. The primary endpoint was the incidence of hyperammonemia. Secondary outcomes included symptoms of hyperammonemia, diagnosis of VPA-induced hyperammonemia, and treatment of VPA-induced hyperammonemia.
A total of 162 patients were included in this study. A total of 33 (20.4%) patients were identified as having the primary outcome of hyperammonemia; 26 (16.0%) patients had symptoms of hyperammonemia, and 13 (8.0%) patients were diagnosed with VPA-induced hyperammonemia. Treatment modalities included administration of lactulose, levocarnitine, discontinuing VPA, or decreasing the VPA dose.
The administration of VPA in the general adult inpatient population resulted in a 20.4% incidence of hyperammonemia, with a lower rate of diagnosed VPA-induced hyperammonemia. Clinicians should be encouraged to obtain ammonia levels in patients receiving VPA if symptoms of altered mental status or encephalopathy develop.
丙戊酸（VPA）广泛用于治疗癫痫、偏头痛及多种精神疾病。据报道，使用VPA引起高氨血症的发生率各不相同。本研究的目的是评估普通成年住院患者中VPA诱发高氨血症的发生率。
纳入2017年6月1日至2017年12月31日期间接受至少1剂VPA及其衍生物治疗的成年患者。如果患者在住院期间未使用VPA，或在开始使用VPA之前氨水平升高（>33μmol/L），则将其排除。确诊为肝硬化的患者也被排除。主要终点是高氨血症的发生率。次要结果包括高氨血症的症状、VPA诱发高氨血症的诊断以及VPA诱发高氨血症的治疗。
本研究共纳入162例患者。共有33例（20.4%）患者被确定为有高氨血症这一主要结果；26例（16.0%）患者有高氨血症症状，13例（8.0%）患者被诊断为VPA诱发的高氨血症。治疗方式包括给予乳果糖、左卡尼汀、停用VPA或降低VPA剂量。
在普通成年住院患者中使用VPA导致高氨血症的发生率为20.4%，而确诊为VPA诱发高氨血症的发生率较低。如果出现精神状态改变或脑病症状，应鼓励临床医生检测接受VPA治疗患者的氨水平。
