A Case of Valproate Induced Hyperammonemic Encephalopathy in an Elderly Bipolar Patient Under Treatment With Sulphonylureas

Maria Salvina Signorelli, Monica Marino, Eliana Battaglia, Marta Massimino, Giuseppe Guastella, Renato Bernardini, Eugenio Aguglia


Valproic acid induced hyperammonaemic encephalopathy (VPA-VHE) is a rare side effect of valproic acid. It is characterized by impaired consciousness and lethargy, focal neurological signs or symptoms with a serum level of ammonia above 40 mmol/L. This syndrome is often misdiagnosed, especially in psychiatricsetting.Wepresentthe case of a bipolar patient who developed VPA-VHE. He assumed also sulphonylureas to manage mild hyperglycemia. After three months of treatment with valproic acid patient had a depressive episode and acute onset of headache, disorientation, consciousness impairment, and psychomotor slowing. This presentation induced to make investigation and we have discovered hyperammonaemia with EEG alteration; a diagnosis of valproate induced hyperammonemic encephalopathy (VHE) was made. The patient recovered quickly after discontinuing valproic acid therapy. Valproic acid is a frequent treatment in psychiatricsetting and a betterknowledge of possibleadverseeffectsisimportant to prevent and manage rare conditions like VHE.

J Med Cases. 2013;4(8):540-543
doi: http://dx.doi.org/10.4021/jmc1313w


Valproic acid; Hyperammonaemic encephalopathy; Bipolar disorder; Elderly

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