---may be underappreciated causes of encephalopathy in hospitalized patients. I recently blogged one example of a nonhepatic hyperammonemia here. Today I found a review in the American Journal of Medicine on the topic. Among the several causes valproic acid, either in therapeutic or excessive levels of use, is the best known. Other causes include infection or GI colonization with urea-splitting bacteria and hyperalimentation. The role of previously undetected metabolic errors such as urea cycle defects is discussed as a susceptibility factor.
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