BACKGROUND Hyperammonemic encephalopathy is a rare and serious adverse reaction to valproate. Although there is documentation of this reaction in previous reports, very little is still known about the exact mechanism of action. In addition, there are no established guidelines of the next steps needed when a patient does develop this reaction. Therefore, this case report highlights what is known as well as the areas of research still needed. CASE PRESENTATION Our patient was a 57-year-old Caucasian woman with a medical history of bipolar I disorder, opioid use disorder, benzodiazepine use disorder, and Crohn's disease who was admitted to our behavioral health unit for suicidal ideation. She had been experiencing multiple panic attacks for 2.5 weeks along with poor sleep, increased energy, excessive spending, and feelings of helplessness. The patient was diagnosed with bipolar I disorder, manic episode without psychotic features, and benzodiazepine use disorder. She was started on valproic acid, citalopram, propranolol, and quetiapine. By day 6 of her hospitalization, the patient had altered mental status, varying levels of consciousness, confusion, and ataxic gait. Her ammonia levels were found to be elevated. All of her medications were discontinued, and lactulose was initiated. She returned to her baseline mentation within 48 hours and was discharged with lithium and quetiapine. The treatment team concluded that this patient had valproate-induced hyperammonemic encephalopathy, a rare but reversible reaction to valproate. CONCLUSION Fortunately, rapid identification of this rare condition led to a favorable outcome in our patient. This case report illustrates the course of treatment in a patient who experienced this reaction and reviews current knowledge as well as areas of needed research in regard to valproate-induced hyperammonemic encephalopathy.

中文翻译：

---

丙戊酸盐诱发的高氨性脑病：一例报告。

背景技术高氨血症性脑病是对丙戊酸的罕见且严重的不良反应。尽管以前的报告中已记录了这种反应，但对于确切的作用机理仍然知之甚少。另外，当患者确实发生此反应时，没有必要的后续步骤指南。因此，本案例报告强调了已知的知识以及仍需要研究的领域。病例介绍我们的患者是一位57岁的白人妇女，她有双相I障碍，阿片类药物使用障碍，苯二氮卓类使用障碍和克罗恩病的病史，被我们行为健康部门录取为自杀意向。她经历了2.5周的多次惊恐发作，并伴有睡眠不足，精力充沛，花费过多和无助感。该患者被诊断出患有双相性I障碍，躁狂发作而无精神病特征和苯二氮卓类使用障碍。她开始服用丙戊酸，西酞普兰，普萘洛尔和喹硫平。到住院的第6天，患者的心理状态发生了变化，意识水平，意识错乱和共济失调的步调有所变化。发现她的氨水平升高。她所有的药物都已停药，并开始服用乳果糖。她在48小时内恢复了基本精神状态，并接受锂和喹硫平治疗。治疗小组得出结论，该患者患有丙戊酸盐诱发的高氨性脑病，这是一种对丙戊酸盐罕见但可逆的反应。结论幸运的是，对这种罕见病的快速鉴定导致了我们患者的良好结局。