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

McMorris, Tressa; Chu, Angela; Vu, Lynn; Bernardini, Amanda

doi:10.9740/mhc.2021.07.243

Cited by 7 publications

(4 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Manual search of reference lists and gray literature did not identify additional studies. After screening and assessing for eligibility, 240 studies were included with the remaining articles being excluded for meeting the exclusion criteria 6,7,12–245 . Among the excluded 350 articles, 37 were literature reviews, 5 were pharmacokinetically related, 41 were VPA overdose related, and 267 articles were unable to clearly answer our objectives listed.…”

Section: Resultsmentioning

confidence: 99%

Valproic Acid–Associated Hyperammonemia

Wong

Fan

Wan

et al. 2023

J Clin Psychopharmacol

View full text Add to dashboard Cite

BackgroundHyperammonemia is an adverse effect that poses clinical uncertainty around valproic acid (VPA) use. The prevalence of symptomatic and asymptomatic hyperammonemia and its relationship to VPA concentration is not well established. There is also no clear guidance regarding its management. This results in variability in the monitoring and treatment of VPA–induced hyperammonemia. To inform clinical practice, this systematic review aims to summarize evidence available around VPA-associated hyperammonemia and its prevalence, clinical outcomes, and management.MethodsAn electronic search was performed through Ovid MEDLINE, Ovid Embase, Web of Science, and PsycINFO using search terms that identified hyperammonemia in patients receiving VPA. Two reviewers independently performed primary title and abstract screening with a third reviewer resolving conflicting screening results. This process was repeated during the full-text review process.ResultsA total of 240 articles were included. Prevalence of asymptomatic hyperammonemia (5%–73%) was higher than symptomatic hyperammonemia (0.7%–22.2%) and occurred within the therapeutic range of VPA serum concentration. Various risk factors were identified, including concomitant medications, liver injury, and defects in carnitine metabolism. With VPA discontinued, most symptomatic patients returned to baseline mental status with normalized ammonia level. There was insufficient data to support routine monitoring of ammonia level for VPA-associated hyperammonemia.ConclusionsValproic acid–associated hyperammonemia is a common adverse effect that may occur within therapeutic range of VPA. Further studies are required to determine the benefit of routine ammonia level monitoring and to guide the management of VPA-associated hyperammonemia.

show abstract

Section: Resultsmentioning

confidence: 99%

Valproic Acid–Associated Hyperammonemia

Wong

Fan

Wan

et al. 2023

J Clin Psychopharmacol

View full text Add to dashboard Cite

show abstract

“…One of the patients of our study was under valproic acid therapy before the diagnosis. Valproic acid induces hyperammonemia as documented in several case reports (Aiyer et al, 2016; McMorris et al, 2021), exacerbating hyperammonemic crises present in UCD and triggering HE (Wu et al, 2021); therefore, its use must be immediately revised. In addition, it is essential to monitor frequent ammonia levels in patients presenting hyperammonemia and HE in use of valproic acid or sodium valproate, to unmask an underlying error of metabolism, such as UCD (Mehta et al, 2018).…”

Section: Discussionmentioning

confidence: 99%

Clinical findings of patients with hyperammonemia affected by urea cycle disorders with hepatic encephalopathy

Lopes

Sitta

Coelho

et al. 2022

Intl J of Devlp Neuroscience

View full text Add to dashboard Cite

Urea cycle disorders (UCD) are a group of genetic diseases caused by deficiencies in the enzymes and transporters involved in the urea cycle. The impairment of the cycle results in ammonia accumulation, leading to neurological dysfunctions and poor outcomes to affected patients. The aim of this study is to investigate and describe UCD patients' principal clinical and biochemical presentations to support professionals on urgent diagnosis and quick management, aiming better outcomes for patients. We explored medical records of 30 patients diagnosed in a referral center from Brazil to delineate UCD clinical and biochemical profile. Patients demonstrated a range of signs and symptoms, such as altered levels of consciousness, acute encephalopathy, seizures, progressive loss of appetite, vomiting, coma, and respiratory distress, in most cases combined with high levels of ammonia, which is an immediate biomarker, leading to a UCD suspicion. The most prevalent UCD detected were ornithine transcarbamylase deficiency, followed by citrullinemia type 1, hyperargininemia, carbamoyl phosphate synthase 1 deficiency, and argininosuccinic aciduria. Clinical symptoms were highly severe, being the majority developmental and neurological disabilities, with 20% of death rate. Laboratory analysis revealed high levels of ammonia (mean AE SD: 860 AE 470 μmol/L; reference value: ≤80 μmol/L), hypoglycemia, metabolic acidosis, and high excretion of orotic acid in the urine (except in carbamoyl phosphate synthetase 1 [CPS1] deficiency). We emphasize the need of urgent identification of UCD clinical and biochemical conditions, and immediate measurement of ammonia, to

show abstract

“…VPA can affect liver and kidney metabolism, resulting in decreased ammonia clearance. Studies have shown that 20.4% of general hospitalized adults receiving VPA develop hyperammonemia 71 . In some cases, hyperammonemia led to severe hyperammonemic encephalopathy 72 .…”

Section: Application Of Pd In Nervous System Diseasesmentioning

confidence: 99%

Exploring the Therapeutic Potential of Peritoneal Dialysis (PD) in the Treatment of Neurological Disorders

Cheng,

Ding,

Kim

et al. 2024

Cell Transplant

View full text Add to dashboard Cite

Peritoneal dialysis (PD) is a well-established renal replacement therapy commonly employed in clinical practice. While its primary application is in the treatment of kidney disease, its potential in addressing other systemic disorders, including neurological diseases, has garnered increasing interest. This study provides a comprehensive overview of the related technologies, unique advantages, and clinical applications of PD in the context of neurological disorders. By exploring the mechanism underlying PD, its application in neurological diseases, and associated complications, we addressed the feasibility and benefits of PD as an adjunct therapy for various neurological conditions. Our study aims to highlight its role in detoxification and symptom management, as well as its advantages over other universally accepted methods of renal replacement therapy. Our goal is to bring to the spotlight the therapeutic potential of PD in neurological diseases, such as stroke, stimulate further research, and broaden the scope of its application in the clinical setting.

show abstract

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

Cited by 7 publications

References 20 publications

Valproic Acid–Associated Hyperammonemia

Valproic Acid–Associated Hyperammonemia

Clinical findings of patients with hyperammonemia affected by urea cycle disorders with hepatic encephalopathy

Exploring the Therapeutic Potential of Peritoneal Dialysis (PD) in the Treatment of Neurological Disorders

Contact Info

Product

Resources

About