Abstract
BackgroundA patient with an early diagnosed epilepsy Valproic acid is one of the most widely used antiepileptic drugs. Hyperammonemic encephalopathy is a rare, but potentially fatal, adverse drug reaction to valproic acid.Case descriptionA patient with an early diagnosed epilepsy, treated with valproic acid, experienced an altered mental state after 10 days of treatment. Valproic acid serum levels were within limits, hepatic function tests were normal but ammonia levels were above the normal range.Valproic acid was stopped and the hyperammonemic encephalopathy was treated with lactulose 15 ml twice daily, metronidazole 250 mg four times daily and L-carnitine 1 g twice daily.Discussion and evaluationMonitoring liver function and ammonia levels should be recommended in patients taking valproic acid. The constraints of the pharmaceutical market had to be taken into consideration and limited the pharmacological options for this patient's treatment.ConclusionsIdiosyncratic symptomatic hyperammonemic encephalopathy is completely reversible, but can induce coma and even death, if not timely detected.Clinical pharmacists can help detecting adverse drug reactions and provide evidence based information for the treatment.
Highlights
A patient with an early diagnosed epilepsy Valproic acid is one of the most widely used antiepileptic drugs
Monitoring liver function and ammonia levels should be recommended in patients taking valproic acid
Cases of hyperammonemia are rarely reported as Valproic acid (VPA)-induced, probably because this increased level of ammonia in blood can vary between asymptomatic, with an incidence of 16-52% (Carr & Sherwsbury 2007), and clinically relevant levels
Summary
Idiosyncratic symptomatic hyperammonemic encephalopathy is completely reversible, but can induce coma and even death, if not timely detected. Clinical pharmacists can help detecting adverse drug reactions and provide evidence based information for the treatment
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