title: Valproate (VPA)-associated hyperammonemic encephalopathy independent of elevated serum VPA levels: 21 cases in China from May 2000 to May 2012.
abstract: Valproate (VPA) is a medication that is widely used in the treatment of neurological and psychiatric disorders, such as epilepsy and bipolar disorder. Valproate-induced hyperammonemic encephalopathy (VHE) is a rare central nervous system adverse effect of this medication that is characterized by impaired consciousness, which can range from drowsiness to coma; increased seizure frequency; acute cognitive symptoms; and gastrointestinal symptoms. In this manuscript, we report a single case and also review previous cases of VHE (n=20) in Chinese patients to identify risk factors for VHE. Increasing clinicians' awareness of VHE during concomitant VPA therapy is of utmost importance. Serum ammonia level is a useful and important diagnostic test. The discontinuation of VPA is currently the mainstay of treatment for VHE.
authors.affiliation: Department of Psychiatry, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510630, Guangdong Province, People's Republic of China.
authors.forename: Minfeng
authors.initials: M
authors.lastname: Cheng
authors.forename: Xiumei
authors.initials: X
authors.lastname: Tang
authors.forename: Shenglin
authors.initials: S
authors.lastname: Wen
authors.forename: Jihui
authors.initials: J
authors.lastname: Yue
authors.forename: Hong
authors.initials: H
authors.lastname: Wang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002675:Child, Preschool; D002681:China; D004827:Epilepsy / Q000188:drug therapy; D005260:Female; D006801:Humans; D022124:Hyperammonemia / Q000139:chemically induced*; D008297:Male; D001523:Mental Disorders / Q000188:drug therapy; D008875:Middle Aged; D020258:Neurotoxicity Syndromes / Q000209:etiology*; D014635:Valproic Acid / Q000009:adverse effects* / Q000097:blood / Q000627:therapeutic use
chemical_list: D014635:Valproic Acid