Abstract
Valproate is an antiepileptic drug which is commonly used for the treatment of focal and/or generalized epilepsy and mood disorders. Valproate is one of the safest first line antiepileptic drug, but like any other drug, it has adverse effects such as nausea, vomiting, drowsiness, tremors, alopecia, menstrual irregularities, polycystic ovarian disease, hepatotoxicity, pancreatitis, thrombocytopenia and rarely hyperammonemia etc. We have reported a case of 22-years-old female of idiopathic generalized epilepsy admitted with eptoin toxicity and subsequently she developed valproate induced non-hepatic hyperammonemia encephalopathy during her hospital stay. Valproate was withheld immediately, and her symptoms resolved after 48 hours.
Highlights
We have presented a case of valproate induced non-hepatic hyperammonemia encephalopathy (VNHE) in a patient admitted in neurology ward with phenytoin toxicity
Symptomatic hyperammonemia in patients on valproate could be due to hepatotoxicity (VHE, incidence 1 in 20,000) and rarely hyperammonemia with normal liver functions tests (VNHE) [1]
Valproate inhibits fatty acid beta oxidation in mitochondria especially in the presence of l-carnitine deficiency which results in decreased production of acetyl Co-A which acts as substrate for N-acetylglutamate
Summary
Valproate is an antiepileptic drug which is commonly used for the treatment of focal and/or generalized epilepsy and mood disorders. Possible differentials in a patient with acute or subacute onset altered mental status on valproate could be drug overdose, valproate induced hepatic encephalopathy (VHE) and hyperammonemia in the absence of liver failure known as valproate induced non-hepatic hyperammonemia encephalopathy (VNHE). We have presented a case of VNHE in a patient admitted in neurology ward with phenytoin toxicity. Patient admitted in neurology ward with a provisional diagnosis of phenytoin toxicity.
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