Valproic Acid Induced Hyperammonemia in a Long TimeTreated Patient

We report a case of a patient who had been on long time valproic acid for treatment of bipolar affective disorder. While beingan inpatient, serology ammonia level testing revealed a veryhigh ammonia level despite being asymptomatic. Dual therapy ofcarnitine and lactulose was provided to the patient for treatment of the hyperammonemia. It should also be noted that, during thistreatment, valproic acid was not stopped. Consequently, this case illustrates that patients can present asymptomatically despite veryhigh ammonia levels and hyperammonemia can occur in chronic valproic acid despite not increasing the dose of the medicationand psychiatrists do not need to discontinue valproic acid in the presence of elevated levels of ammonia if the patient shows nosigns of encephalopathy or delirium.