RT Journal Article
SR Electronic
T1 Valproate-induced hyperammonemia in asymptomatic children
JF Cleveland Clinic Journal of Medicine
JO Cleve Clin J Med
FD Cleveland Clinic
SP 275
OP 277
VO 50
IS 3
A1 Wyllie, Elaine
A1 Wyllie, Robert
A1 Rothner, A. David
A1 Erenberg, Gerald
A1 Cruse, Robert P.
YR 1983
UL http://www.ccjm.org/content/50/3/275.abstract
AB Since its introduction in the United States in 1978 for treatment of seizure disorders, valproic acid (VPA) has been associated with hepatic dysfunction. Patients who received VPA have developed a spectrum of toxicity from fulminant hepatic failure to lethargy with elevated serum ammonia levels and normal transaminase. To determine the frequency of hyperammonemia, venous ammonia levels were obtained in three groups of asymptomatic patients: 16 receiving VPA only, 40 receiving VPA plus other anticonvulsants, and 32 control patients receiving a variety of other seizure medications. Seventy-three percent of patients receiving VPA had elevated serum ammonia levels greater than 45 Mg/dl compared to 28% of the control group (p < 0.0001). In 88% of the patients receiving VPA, the serum VPA level was <110 gg/ml (therapeutic range, 50-100 gg/ml), and all VPA levels were <168 gg/ml. There was no correlation between serum VPA levels and ammonia levels. Patients receiving VPA demonstrated hyperammonemia more frequently than did the control group, regardless of the concurrent use of additional anticonvulsants.