Abstract Hyperammonemia can often appear in the presence of supratherapeutic serum concentrations of valproic acid (VPA) or, less frequently, as a result of drug-drug interactions. Zonisamide (ZON), much like topiramate (TPM), is a carbonic anhydrase inhibitor which may provoke hyperammonemia when co-administered with VPA. We present a rare case of hyperammonemia with minimal dosage increase of valproic acid (VPA) in the setting of stable doses of the anticonvulsants (ZON) and levetiracetam (LEV). Brain MRI findings of cytotoxic edema were found alongside severely elevated ammonia levels warranting the discontinuation of VPA. As a result, gradual improvement occurred.

中文翻译：

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丙戊酸和唑尼沙胺诱导的高氨血症性脑病

摘要 高氨血症通常在丙戊酸 (VPA) 血清浓度超过治疗水平的情况下出现，或者在较少情况下是药物相互作用的结果。唑尼沙胺 (ZON) 与托吡酯 (TPM) 非常相似，是一种碳酸酐酶抑制剂，与 VPA 合用时可能会引起高氨血症。我们提出了一个罕见的高氨血症病例，在稳定剂量的抗惊厥药 (ZON) 和左乙拉西坦 (LEV) 的情况下，丙戊酸 (VPA) 的剂量增加最小。脑 MRI 发现细胞毒性水肿，同时发现氨水平严重升高，需要停用 VPA。结果，逐渐发生了改善。