title: Hyperammonemia and coma without hepatic dysfunction induced by valproate therapy.
abstract: The authors report a case of a 41-year-old mentally disabled man with bipolar disorder who presented to the emergency department with altered mental status. He was found to have a significantly elevated ammonia level (377 microM/L) with no signs of hepatic insufficiency. His coma and hyperammonemia were attributed to his chronic valproate therapy. This patient had the highest serum ammonia level ever reported with a therapeutic valproate level in the absence of any other anticonvulsant therapy, metabolic abnormality, or hepatic dysfunction. The authors discuss this case and review the current literature on hyperammonemia in valproic acid therapy and the use of L-carnitine in these patients.
authors.affiliation: Pitt County Memorial Hospital, Brody School of Medicine, East Carolina University, Greenville, NC, USA. fbarrueto@hotmail.com
authors.forename: F
authors.initials: F
authors.lastname: Barrueto
authors.forename: J B
authors.initials: JB
authors.lastname: Hack
mesh_terms: D000328:Adult; D000927:Anticonvulsants / Q000009:adverse effects*; D003128:Coma / Q000139:chemically induced* / Q000150:complications; D006801:Humans; D022124:Hyperammonemia / Q000139:chemically induced* / Q000150:complications; D008099:Liver / Q000187:drug effects* / Q000503:physiopathology*; D017093:Liver Failure / Q000139:chemically induced*; D008297:Male; D014635:Valproic Acid / Q000009:adverse effects* / Q000627:therapeutic use*
chemical_list: D000927:Anticonvulsants; D014635:Valproic Acid