Ayşe SERDAROĞLU, Ercan DEMİR, Ebru ARHAN PETEK, Aysel AKSU ÜNLÜSOY, Ayşe Aysima ÖZÇELİK, Kıvılcım GÜCÜYENER

Case: Valproat-Induced Hyperammonemic Encephalopathy

Valproat ilişkili ensefalopati, ilacın ağır bir yan etkisi olarak görülmektedir. Olgu, tedaviye valproik asit eklendikten sonra hiperamonemi ve akut ensefalopati ile uyumlu mental değişiklikle başvurmuştur. Plazma amonyak düzeyleri normal düzeyin iki katı kadar yüksek iken, karaciğer fonksiyon testleri normaldi. Plazma valproik asit düzeyi normal sınırlardaydı. Valproat kesilip, L-karnitin eklendikten sonra semptomları düzeldi. Bu olguyla birlikte, hiperamonemi ve ensefalopatinin olası mekanizmaları ve bu hastalarda Lkarnitin tedavisinin etkinliği tartışılmıştır.

Olgu: Valproat ile İndüklenen Hiperamonemik Ensefalopati

Valproate induced hyperammonemic encephalopathy (VHE) is a severe adverse effect of medicine. An epileptic patient with an acute hyperammonemia after the addition of valproic acid to his treatment presented with acute mental status changes consistent with encephalopathy. Notably, plasma ammonia level was 2 times of the upper limit, despite normal liver function tests. Plasma valproic acid level was in the therapeutic range. His symptoms resolved with the discontinuation of valproic acid and Lcarnitine administration. We discuss this case and review the possible mechanisms of valproic acid-associated encephalopathy and the efficacy of L-carnitine.

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