Here is a review post in
Academic Life in Emergency Medicine.
Points of interest:
As valproic acid (VA) is seeing
expanded indications this is an increasingly appreciated entity.
A metabolite of VA can inhibit the urea
cycle, leading to raised ammonia levels.
The problem can occur early in the
course of treatment or after long periods of tolerance of the drug.
It can occur with VA levels in the
therapeutic range.
In addition to altered mental status,
increased seizure frequency and GI manifestations can be presenting
symptoms.
In addition to withdrawal of VA, IV
carnitine therapy may be indicated.
1 comment:
Treated a case this past weekend of VPA od whose ammonia went from 54 to 254 and had decreased MS. Treated with IV carnitine with reduction of ammonia and improvement.
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