Hyperammonemia in patients receiving valproic acid in the hospital setting: A retrospective review.

The Mental Health Clinician Pub Date : 2021-07-16 eCollection Date: 2021-07-01 DOI:10.9740/mhc.2021.07.243
Tressa McMorris, Angela Chu, Lynn Vu, Amanda Bernardini
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引用次数: 4

Abstract

Introduction: Valproic acid (VPA) is widely used for the treatment of epilepsy, migraine, and a variety of psychiatric conditions. The reported incidences of hyperammonemia induced by VPA use is variable. The purpose of this study is to evaluate the incidence of VPA-induced hyperammonemia in the general adult inpatient population.

Methods: Adult patients who received at least 1 dose of VPA and derivatives between June 1, 2017 to December 31, 2017 were included. Patients were excluded if they did not have VPA administered during their inpatient stay or if they had elevated ammonia levels (>33 μmol/L) prior to initiation of VPA. Patients with a confirmed diagnosis of liver cirrhosis were also excluded. The primary endpoint was the incidence of hyperammonemia. Secondary outcomes included symptoms of hyperammonemia, diagnosis of VPA-induced hyperammonemia, and treatment of VPA-induced hyperammonemia.

Results: A total of 162 patients were included in this study. A total of 33 (20.4%) patients were identified as having the primary outcome of hyperammonemia; 26 (16.0%) patients had symptoms of hyperammonemia, and 13 (8.0%) patients were diagnosed with VPA-induced hyperammonemia. Treatment modalities included administration of lactulose, levocarnitine, discontinuing VPA, or decreasing the VPA dose.

Discussion: The administration of VPA in the general adult inpatient population resulted in a 20.4% incidence of hyperammonemia, with a lower rate of diagnosed VPA-induced hyperammonemia. Clinicians should be encouraged to obtain ammonia levels in patients receiving VPA if symptoms of altered mental status or encephalopathy develop.

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在医院接受丙戊酸治疗的患者的高氨血症:一项回顾性回顾。
简介:丙戊酸(VPA)广泛用于治疗癫痫、偏头痛和各种精神疾病。使用VPA引起的高氨血症的发生率是可变的。本研究的目的是评估vpa引起的高氨血症在普通成年住院患者中的发生率。方法:纳入2017年6月1日至2017年12月31日期间接受至少1剂VPA及其衍生物的成年患者。如果患者在住院期间没有使用VPA,或者在VPA开始之前氨水平升高(>33 μmol/L),则排除患者。确诊为肝硬化的患者也被排除在外。主要终点是高氨血症的发生率。次要结局包括高氨血症的症状、vpa诱导的高氨血症的诊断以及vpa诱导的高氨血症的治疗。结果:本研究共纳入162例患者。共有33例(20.4%)患者被确定为主要结局为高氨血症;26例(16.0%)患者出现高氨血症症状,13例(8.0%)患者诊断为vpa所致高氨血症。治疗方式包括乳果糖、左卡尼汀、停用VPA或减少VPA剂量。讨论:普通成人住院患者服用VPA导致20.4%的高氨血症发生率,诊断为VPA引起的高氨血症发生率较低。如果出现精神状态改变或脑病症状,应鼓励临床医生在接受VPA的患者中检测氨水平。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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