30 January 2007
Unconsciousness due to hyperammonemia in association with valproic acid – two case reports
Jana Ambrožič, Miran Brvar, Matjaž BuncCase Rep Clin Pract Rev 2007; 8:32-35 :: ID: 470699
Abstract
Background: Hyperammonemia as a cause of unconsciousness in adult patients is mostly related to liver dysfunction. However, elevated plasma ammonia without signs of liver failure can be associated with valproic acid (VPA), an antiepileptic drug. We report two patients with acute unconsciousness, hyperammonemia and normal liver function in association with VPA.
Case Report: A 23-year-old female on chronic VPA therapy attempted suicide by taking 100 tablets of VPA. She had elevated plasma ammonia (250 µmol/L) and serum VPA concentration (3250 µmol/L). After discontinuation of VPA her mental status improved together with normalization of plasma ammonia and serum VPA level. After restarting her chronic VPA therapy plasma ammonia
level remained normal and serum VPA concentration within the therapeutic range. A 34-year-old male on chronic VPA therapy presented with acute unconsciousness and hyperammonemia (326 µmol/L). He had stable VPA dosing and serum VPA concentration within the therapeutic range (354 µmol/L). Following discontinuation of VPA we observed improvement of his mental status and decreasing of ammonia level. After we reinitiated VPA
therapy, his mental status worsened again in correlation to increased ammonia level.
Conclusions: Hyperammonemia with central nervous depression may develop in acute VPA overdose as well as in chronic VPA therapy with stable dosing without any obvious acute clinical event. In patients with unexplained unconsciousness measurement of plasma ammonia is an important screening test.
Keywords: Valproic Acid, Unconsciousness, Ammonia, liver function
14
In Press
12 Feb 2024 : Case report
Diagnostic Challenges and Imaging Considerations for Intraparotid Facial Nerve Schwannoma: A Case Report an...Am J Case Rep In Press; DOI: 10.12659/AJCR.942870
12 Feb 2024 : Case report
Erdheim-Chester Disease Occult on Radiographs and CT but Visible on MRI and PETAm J Case Rep In Press; DOI: 10.12659/AJCR.941169
12 Feb 2024 : Case report
Surgical Treatment of Spontaneous Superficial Temporal Artery Arteriovenous Malformation: A Case ReportAm J Case Rep In Press; DOI: 10.12659/AJCR.942839
13 Feb 2024 : Case report
Warfarin Woes: A Rare Case of Hemoperitoneum with Intramural Small Bowel HematomaAm J Case Rep In Press; DOI: 10.12659/AJCR.943519
Most Viewed Current Articles
10 Jan 2022 : Case report
A Report on the First 7 Sequential Patients Treated Within the C-Reactive Protein Apheresis in COVID (CACOV...DOI :10.12659/AJCR.935263
Am J Case Rep 2022; 23:e935263
19 Jul 2022 : Case report
Atlantoaxial Subluxation Secondary to SARS-CoV-2 Infection: A Rare Orthopedic Complication from COVID-19DOI :10.12659/AJCR.936128
Am J Case Rep 2022; 23:e936128
05 Mar 2022 : Case report
Acute Limb Ischemia After Self-Injection of Crushed Morphine Tablets into the Radial Artery: Role of Infrar...DOI :10.12659/AJCR.935336
Am J Case Rep 2022; 23:e935336
02 Apr 2022 : Case report
Infective Endocarditis Caused by Pseudomonas luteola in a Pediatric Patient. A Case Report and Review of Li...DOI :10.12659/AJCR.935743
Am J Case Rep 2022; 23:e935743