Hyperammonaemia in Absence of Deranged Liver Enzymes with Valproate: A Case Report

Abstract

Valproate is used for various neurological and psychiatric conditions. It has various adverse effects, most
of which are mild and transient, however, hyperammonaemia in the absence of abnormal liver function
is an uncommon and life-threatening side effect. The exact mechanism for this is unknown, but several
mechanisms have been described for the same. We present a case of 11-year-old male patient belonging
to a broken family. Initially he was diagnosed as a case of ADHD with conduct disorder. However due to
non-response to medications, over time, a EEG was done and was found to have generalised epileptiform
discharges, He was maintaining well on Valproate, but had an acute exacerbation of symptoms on being
off medications for 2 weeks and grandmother restarting Valproate in high dose. Response to the treatment
provided to the patient was rewarding.