Abstract
Aim: Valproic acid is an anticonvulsant and mood stabilizer used in various psychiatric and neurological conditions with a wide therapeutic window. This case report aims to emphasize that taking a drug in patients receiving psychiatric treatment can be toxic even if it is not at a toxic level.
Case: A 33-year-old male patient was brought to the emergency room with complaints of decreased speech, slow movements, unresponsiveness, and blank stare for several days. According to the anamnesis taken from his father, it was learned that he had a known bipolar disorder and that his current complaints had increased for 2-3 days. Vital values were stable. The patient's laboratory and radiological examinations were within normal limits. When it was learned that valproic acid treatment had just started, drug level and ammonia level tests were requested considering the possibility of side effects. A diagnosis of hyperammonemia-induced encephalopathy was made due to high ammonia levels.
Conclusion: While the treatment for valproic acid side effects is to discontinue the drug and follow up, in our patient, simply discontinuing the drug was not enough and he required hemodialysis treatment. With this case, we wanted to remind that hemodialysis can also be used in VPA-induced encephalopathy.
Keywords
References
- 1. Apa F, Çulha Ateşci F, Sözeri Varma G. Valproik asit kullanımına bağlı gelişen hiperamonyemik ensefalopati: olgu sunumu. Klinik Psikiyatri. 2018;21:102-6.
- 2. Pradeep RJ. Valproate monotherapy induced-delirium due to hyperammonemia: a report of three adult cases with different types of presentation. Indian J Psychiatry. 2008;50:121-3.
- 3. Wu YF. Recurrent hyperammonemia associated with olanzapine. J Clin Psychopharmacol. 2017;37:366-7.
- 4. Sousa C. Valproic acid-induced hyperammonemic encephalopathy-a potentially fatal adverse drug reaction. Springerplus. 2013;2:13.
- 5. Hosseini H, Shafie M, Shakiba A, Ghayyem H, Mayeli M, Hassani M, et al. Valproic acid-induced hyperammonemia in neuropsychiatric disorders: a 2-year clinical survey. Psychopharmacology (Berl). 2023;240:149-56.
- 6. Rodriques-Silva N, Venâncio Â, Bouça J. Risperidone, a risk factor for valproate-induced encephalopathy Gen Hosp Psychiatry. Gen Hosp Psychiatry. 2013;35:452.e5-6.
- 7. Chopra A, Kolla BP, Mansukhani MP, Netzel P, Frye MA. Valproate-induced hyperammonemic encephalopathy: an update on risk factors, clinical correlates and management. Gen Hosp Psychiatry. 2012;34:290–8.
- 8. Iqbal K, Kummamuru H, Dasari N, Koritala T, Jain NK, Deepika K, et al. A case of valproic-acid induced hyperammonemic encephalopathy. Cureus. 2021;13:e20380.
Abstract
Amaç: Valproik asit, çeşitli psikiyatrik ve nörolojik durumlarda kullanılan geniş bir terapötik pencereye sahip bir antikonvülsan ve ruh hali dengeleyicidir. Bu olgu sunumu, psikiyatrik tedavi gören hastalarda ilacın toksik düzeyde olmasa bile toksik olabileceğini vurgulamayı amaçlamaktadır.
Olgu: 33 yaşında erkek hasta, birkaç gündür olan konuşmada azalma, hareketlerde yavaşlama, tepkisizlik ve boş bakış şikayetleriyle acil servise getirildi. Babasından alınan anamnezde, bilinen bipolar bozukluk olduğu ve mevcut şikayetlerinin 2-3 gündür arttığı öğrenildi. Vital değerleri stabil seyretti. Hastanın laboratuvar ve radyolojik incelemeleri normal sınırlardaydı. Valproik asit tedavisine yeni başlandığı öğrenilince yan etki olasılığı düşünülerek ilaç düzeyi ve amonyak düzeyi testleri istendi. Yüksek amonyak düzeyi nedeniyle hiperamonyemi kaynaklı ensefalopati tanısı konuldu.
Sonuç: Valproik asit yan etkilerinin tedavisi ilacı kesmek ve takip etmek iken, bizim hastamızda sadece ilacı kesmek yeterli olmamış ve hemodiyaliz tedavisine ihtiyaç duyulmuştur. Bu vaka ile hemodiyalizin VPA kaynaklı ensefalopatide de kullanılabileceğini hatırlatmak istedik.
Keywords
References
- 1. Apa F, Çulha Ateşci F, Sözeri Varma G. Valproik asit kullanımına bağlı gelişen hiperamonyemik ensefalopati: olgu sunumu. Klinik Psikiyatri. 2018;21:102-6.
- 2. Pradeep RJ. Valproate monotherapy induced-delirium due to hyperammonemia: a report of three adult cases with different types of presentation. Indian J Psychiatry. 2008;50:121-3.
- 3. Wu YF. Recurrent hyperammonemia associated with olanzapine. J Clin Psychopharmacol. 2017;37:366-7.
- 4. Sousa C. Valproic acid-induced hyperammonemic encephalopathy-a potentially fatal adverse drug reaction. Springerplus. 2013;2:13.
- 5. Hosseini H, Shafie M, Shakiba A, Ghayyem H, Mayeli M, Hassani M, et al. Valproic acid-induced hyperammonemia in neuropsychiatric disorders: a 2-year clinical survey. Psychopharmacology (Berl). 2023;240:149-56.
- 6. Rodriques-Silva N, Venâncio Â, Bouça J. Risperidone, a risk factor for valproate-induced encephalopathy Gen Hosp Psychiatry. Gen Hosp Psychiatry. 2013;35:452.e5-6.
- 7. Chopra A, Kolla BP, Mansukhani MP, Netzel P, Frye MA. Valproate-induced hyperammonemic encephalopathy: an update on risk factors, clinical correlates and management. Gen Hosp Psychiatry. 2012;34:290–8.
- 8. Iqbal K, Kummamuru H, Dasari N, Koritala T, Jain NK, Deepika K, et al. A case of valproic-acid induced hyperammonemic encephalopathy. Cureus. 2021;13:e20380.
Details
| Primary Language | English |
|---|---|
| Subjects | Emergency Medicine |
| Journal Section | Case Reports |
| Authors | |
| Publication Date | June 12, 2025 |
| Submission Date | April 24, 2025 |
| Acceptance Date | May 22, 2025 |
| Published in Issue | Year 2025 Volume: 4 Issue: 2 |
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