Treatment of Valproate-Induced Hyperammonemia

The document discussed a case of valproate-induced hyperammonemia in a 79-year-old man with paranoid schizophrenia, who developed lethargy and confusion after his valproate dosage was increased. Despite normal liver enzymes and therapeutic valproate levels, his serum ammonia level was elevated. Treatment involved discontinuing valproate, intravenous hydration, protein restriction, and lactulose, leading to rapid recovery. This was noted as the first report of using lactulose for this condition, highlighting the need to consider hyperammonemia in patients on valproic acid, as its mechanism is linked to urea cycle inhibition.