title: Valproic acid-induced hyperammonaemic coma and unrecognised portosystemic shunt.
abstract: Hyperammonaemic encephalopathy is a rare and potentially fatal complication of valproic acid treatment. The clinical presentation of hyperammonaemic encephalopathy is wide and includes seizures and coma. We present a case of hyperammonaemic coma precipitated by sodium valproate use for symptomatic epilepsy in a patient with unrecognised portosystemic shunt, secondary to earlier alcoholism. The absence of any stigmata of chronic liver disease and laboratory markers of liver dysfunction delayed the recognition of this alcohol-related complication. The portal vein bypass led to a refractory, valproic acid-induced hyperammonaemic coma. The patient fully recovered after dialysis treatment.
authors.affiliation: Neurology Department, Faro Hospital, Faro, Portugal. nzwalo@gmail.com
authors.forename: Hipólito
authors.initials: H
authors.lastname: Nzwalo
authors.forename: Leonor
authors.initials: L
authors.lastname: Carrapatoso
authors.forename: Fátima
authors.initials: F
authors.lastname: Ferreira
authors.forename: Carlos
authors.initials: C
authors.lastname: Basilio
mesh_terms: D000927:Anticonvulsants / Q000009:adverse effects*; D003128:Coma / Q000139:chemically induced* / Q000209:etiology; D006801:Humans; D022124:Hyperammonemia / Q000139:chemically induced* / Q000209:etiology; D006975:Hypertension, Portal / Q000150:complications*; D008108:Liver Diseases, Alcoholic / Q000150:complications*; D008297:Male; D008875:Middle Aged; D014635:Valproic Acid / Q000009:adverse effects*
chemical_list: D000927:Anticonvulsants; D014635:Valproic Acid
keywords: coma; hyperammonemia; portosystemic shunt; valproic acid