Pavar Gautham, Xu Nicole, Sawar Kinan, Trivedi Vichar, Levine Diane L
Medicine, Wayne State University School of Medicine, Detroit, USA.
Ophthalmology, Wayne State University, Detroit Medical Center, Detroit, USA.
Cureus. 2023 Jan 9;15(1):e33559. doi: 10.7759/cureus.33559. eCollection 2023 Jan.
Patients presenting with hyperammonemic encephalopathy are likely to have hepatic encephalopathy. However, valproate (an anticonvulsant and mood stabilizer) can also cause hyperammonemic encephalopathy and belongs on the differential for patients taking it, especially if there are recent contributory medication changes. We present a case report of a 61-year-old woman with valproate-induced hyperammonemic encephalopathy but with an initial valproate level within the therapeutic range (50-100 mcg/dL). After withholding valproate and before additional treatment could be initiated, she became fully alert and oriented. We present a literature review exploring valproate toxicity and treatment. Our case shows that clinical suspicion for valproate-induced hyperammonemic encephalopathy is warranted even if the valproate level is within the therapeutic range.
出现高氨血症性脑病的患者很可能患有肝性脑病。然而，丙戊酸盐（一种抗惊厥药和情绪稳定剂）也可导致高氨血症性脑病，对于服用该药的患者，尤其是近期有相关用药变化的患者，应将其列入鉴别诊断范围。我们报告一例61岁女性丙戊酸盐诱发的高氨血症性脑病病例，但其初始丙戊酸盐水平在治疗范围内（50 - 100 mcg/dL）。停用丙戊酸盐后且在开始额外治疗之前，她变得完全清醒且定向力正常。我们进行了一项文献综述，探讨丙戊酸盐毒性及治疗方法。我们的病例表明，即使丙戊酸盐水平在治疗范围内，也有必要对丙戊酸盐诱发的高氨血症性脑病进行临床怀疑。
