Valproic acid induced hyperammonaemic encephalopathy: case report

Abstract

Hyperammonemia is a well-known adverse effect of valproic acid therapy. In the recent years, encephalopathy cases triggered by vaproic acid userelated hyperammonemia have been reported and regular blood ammonium level follow-up is suggested. Polypharmacy, malnutrition, urea cycle disorders are risk factors for encephalopathy triggered by vaproic acid related hyperammonemia. Here, we report a case of symptomatic non-hepatic encephalopathy during valproic acid treatment combined with electroconvulsive therapy (ECT). Valproic acid may have induced hyperammonemic encephalopathy in combination with the anesthetic agent propofol. We may suggest that patients receiving combination of valproic acid and propofol as induction agents for ECT, clinicians should be careful for the development of hyperammonaemic encephalopathy.