title: Case report: valproic Acid and risperidone treatment leading to development of hyperammonemia and mania.
abstract: This case report describes two children who developed hyperammonemia together with frank manic behavior during treatment with a combination of valproic acid and risperidone. One child had been maintained on valproic acid for years and risperidone was added. In the second case, valproic acid was introduced to a child who had been treated with risperidone for years. In both cases, discontinuing the valproic acid resulted in normalization of ammonia levels and cessation of the manic behavior. This case report alerts physicians to the importance of obtaining serum ammonia levels in children treated with valproic acid and risperidone who present with manic behavior.
authors.affiliation: Drs. Carlson and Caplan are with the Department of Psychiatry at the UCLA Semmel Institute of Neuroscience and Human Behavior, UCLA Medical Center, Los Angeles; and Dr. Reynolds is with the Department of Pharmaceutical Services at the Lynda and Stewart Resnick Neuropsychiatric Hospital, UCLA Medical Center. Electronic address: tcarlson@mednet.ucla.edu.
authors.forename: Teri
authors.initials: T
authors.lastname: Carlson
authors.affiliation: Drs. Carlson and Caplan are with the Department of Psychiatry at the UCLA Semmel Institute of Neuroscience and Human Behavior, UCLA Medical Center, Los Angeles; and Dr. Reynolds is with the Department of Pharmaceutical Services at the Lynda and Stewart Resnick Neuropsychiatric Hospital, UCLA Medical Center.
authors.forename: Charles A
authors.initials: CA
authors.lastname: Reynolds
authors.affiliation: Drs. Carlson and Caplan are with the Department of Psychiatry at the UCLA Semmel Institute of Neuroscience and Human Behavior, UCLA Medical Center, Los Angeles; and Dr. Reynolds is with the Department of Pharmaceutical Services at the Lynda and Stewart Resnick Neuropsychiatric Hospital, UCLA Medical Center.
authors.forename: Rochelle
authors.initials: R
authors.lastname: Caplan
mesh_terms: D014150:Antipsychotic Agents / Q000009:adverse effects*; D020817:Asperger Syndrome / Q000188:drug therapy / Q000523:psychology; D001289:Attention Deficit Disorder with Hyperactivity / Q000150:complications / Q000188:drug therapy; D001714:Bipolar Disorder / Q000139:chemically induced* / Q000175:diagnosis / Q000523:psychology; D002648:Child; D004359:Drug Therapy, Combination; D006801:Humans; D022124:Hyperammonemia / Q000139:chemically induced* / Q000175:diagnosis; D008297:Male; D018967:Risperidone / Q000009:adverse effects* / Q000627:therapeutic use; D014635:Valproic Acid / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D014150:Antipsychotic Agents; D014635:Valproic Acid; D018967:Risperidone