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CC BY-NC-ND 4.0 · International Journal of Epilepsy 2017; 04(02): 181-183
DOI: 10.1016/j.ijep.2017.09.002
Case report
Thieme Medical and Scientific Publishers Private Ltd.

A fatal case of valproate-induced hyperammonemic encephalopathy: An update on proposed pathogenic mechanisms and treatment options

Yeung Gloria Wai Yue
a   Department of Neurosurgery, Kwong Wah Hospital, 25 Waterloo Road, Hong Kong Special Administrative Region
,
Chau Kei Wai
b   Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region
,
Woo Yat Ming Peter
a   Department of Neurosurgery, Kwong Wah Hospital, 25 Waterloo Road, Hong Kong Special Administrative Region
,
Wong Hoi Tung
a   Department of Neurosurgery, Kwong Wah Hospital, 25 Waterloo Road, Hong Kong Special Administrative Region
,
Chan Kwong Yau
a   Department of Neurosurgery, Kwong Wah Hospital, 25 Waterloo Road, Hong Kong Special Administrative Region
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Publikationsverlauf

Received: 24. Mai 2017

Accepted: 13. September 2017

Publikationsdatum:
10. Mai 2018 (online)

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1

Introduction

Sodium valproate is widely used in a range of disorders including seizures, psychiatric conditions and chronic pain syndromes. Although it has a relatively favourable safety profile, it is associated with severe idiosyncratic adverse effects, the most notable being valproate-induced hyperammonemic encephalopathy (VHE), a rare phenomenon with fewer than 150 cases documented in the last 10 years.[1] The clinical presentation of VHE may be subtle and if left untreated also fatal.[2] [3] This case report illustrates the importance early recognition and management of this rare and lethal adverse effect.

 

  • References

  • 1 Nanau RM, Neuman MG. Adverse drug reactions induced by valproic acid. Clin Biochem 46 (15) 2013; 1323-1338 10.1016/j.clinbiochem.2013.06.012 [published Online First: 20 June 2013]
    CrossrefPubMedGoogle Scholar
  • 2 Verrotti A, Trotta D, Morgese G. et al. Valproate-induced hyperammonemic encephalopathy. Metab Brain Dis 17 (04) 2002; 367-373
    CrossrefPubMedGoogle Scholar
  • 3 Sousa C. Valproic acid-induced hyperammonemic encephalopathy − a potentially fatal adverse drug reaction. Springerplus 2 (01) 2013; 13 10.1186/2193-1801-2-13 [published Online First: 15 January 2013]
    CrossrefPubMedGoogle Scholar
  • 4 Chicharro AV, de Marinis AJ, Kanner AM. The measurement of ammonia blood levels in patients taking valproic acid: looking for problems where they do not exist?. Epilepsy Behav 11 (03) 2007; 361-366 10.1016/j.yebeh.2007.06.015 [published Online First: 12 September 2007]
    CrossrefPubMedGoogle Scholar
  • 5 Lewis C, Deshpande A, Tesar GE, Dale R. Valproate-induced hyperammonemic encephalopathy: a brief review. Curr Med Res Opin 28 (06) 2012; 1039-1042 10.1185/03007995.2012.694362 [published Online First: 6 June 2012]
    CrossrefPubMedGoogle Scholar
  • 6 Chopra A, Kolla BP, Mansukhani MP, Netzel P, Frye MA. Valproate-induced hyperammonemic encephalopathy: an update on risk factors, clinical correlates and management. Gen Hosp Psychiatry 34 (03) 2012; 290-298 10.1016/j.genhosppsych.2011.12.009 [published Online First: 2 February 2012]
    CrossrefPubMedGoogle Scholar
  • 7 Au J, Pockros PJ. Drug-induced liver injury from antiepileptic drugs. Clin Liver Dis 68 2013; 687-697
    PubMedGoogle Scholar
  • 8 Eubanks AL, Aguirre B, Bourgeois JA. Severe acute hyperammonemia after brief exposure to valproate. Psychosomatics 49 (01) 2008; 82-83 10.1176/appi.psy.49.1.82
    CrossrefPubMedGoogle Scholar
  • 9 Rigamonti A, Lauria G, Grimod G, Salmaggi A. Valproate induced hyperammonemic encephalopathy successfully treated with levocarnitine. J Clin Neurosci 21 (04) 2014; 690-691 10.1016/j.jocn.2013.04.033 [published Online First: 8 October 2013]
    CrossrefPubMedGoogle Scholar
  • 10 Mock CM, Schwetschenau KH. Levocarnitine for valproic-acid-induced hyperammonemic encephalopathy. Am J Health Syst Pharm 69 (01) 2012; 35-39 10.2146/ajhp110049
    CrossrefPubMedGoogle Scholar
  • 11 Bega D, Vaitkevicius H, Boland TA, Murray M, Chou SHY. Fatal hyperammonemic brain injury from valproic Acid exposure. Case Rep Neurol 4 (03) 2012; 224-230 10.1159/000345226 [published Online First: 11 December 2012]
    CrossrefPubMedGoogle Scholar
  • 12 Daniotti M, la Marca G, Fiorini P, Filippi L. New developments in the treatment of hyperammonemia: emerging use of carglumic acid. Int J Gen Med 4 2011; 21-28 10.2147/IJGM.S10490
    PubMedGoogle Scholar
  • 13 Connolly ES, Rabinstein AA, Carhuapoma JR. et al. Guidelines for the management of aneurysmal subarachnoid hemorrhage. Stroke 2012; 43 10.1161/STR.0b013e3182587839
    PubMedGoogle Scholar
  • 14 Muck W, Ahr G, Nimodipine KulhmannJ. Potential for drug–drug interactions in the elderly. Drugs Aging 6 (03) 1995; 229-242
    CrossrefPubMedGoogle Scholar
  • 15 Glauser T, Shinnar S, Gloss D. et al. Evidence-based guideline: treatment of convulsive status epilepticus in children and adults: report of the guideline committee of the American epilepsy society. Epilepsy Currents 16 (01) 2016; 48-61
    CrossrefPubMedGoogle Scholar