Carbamazepine/valproate
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Reactions 1411 - 21 Jul 2012 S Carbamazepine/valproate Hyperammonaemic encephalopathy and syndrome of inappropriate secretion of antiduretic hormone: case report A 16-year-old boy developed hyperammonaemic encephalopathy and syndrome of inappropriate secretion of antidiuretic hormone (SIADH) during treatment with valproate and carbamazepine, respectively [routes not stated]. The boy, who had a history of neonatal hypoglycaemia, prolonged intensive care treatment, septicaemia, complex partial seizures with secondary generalisation from childhood, hypothyroidism, dyslexia, below-average level of functioning and bipolar disorder, was taking valproate for a manic episode that followed a depressive episode. Two weeks after his valproate dose was increased to 2000mg [initial dose not stated; frequency not stated], he developed urinary incontinence and disoriented behaviour. Of note, he developed hyperammonaemic encephalopathy 6 weeks after valproate initiation. Valproate was withdrawn for suspected toxicity. The patient’s arterial ammonia level was 150 mmol/L. He got better, and his serum ammonia decreased to 35 mmol/L. His carbamazepine dose was increased from 400mg to 800 mg/day for symptom control [indication not clearly stated]. Olanzapine was started as well. His serum sodium level, which was initially normal, was less than 125 mEq/L [duration of treatment to reaction onset not stated] due to carbamazepine. He was diagnosed with SIADH due to carbamazepine. His carbamazepine dose was reduced to 400mg as before, and his urine sodium level got corrected. Lithium was started for behaviour control. Of note, he was suspected of having an undiagnosed urea cycle disorder. Author comment: "[The patient] had hyperammonemic encephalopathy 6 weeks following valproate initiation [and had] hyponatraemia due to carbamazepine." Ajeesh PR, et al. A case of bipolar disorder with hyerammonemia due to valproate and hyponatremia due to carbamazepine. Indian Journal of Psychiatry 53 (Suppl. 1): 74, No. 5, Apr 2011 [abstract] - India 803073405 1 Reactions 21 Jul 2012 No. 1411 0114-9954/10/1411-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Transcript of Carbamazepine/valproate
Reactions 1411 - 21 Jul 2012
SCarbamazepine/valproate
Hyperammonaemic encephalopathy andsyndrome of inappropriate secretion ofantiduretic hormone: case report
A 16-year-old boy developed hyperammonaemicencephalopathy and syndrome of inappropriate secretionof antidiuretic hormone (SIADH) during treatment withvalproate and carbamazepine, respectively [routes notstated].
The boy, who had a history of neonatal hypoglycaemia,prolonged intensive care treatment, septicaemia, complexpartial seizures with secondary generalisation fromchildhood, hypothyroidism, dyslexia, below-average levelof functioning and bipolar disorder, was taking valproatefor a manic episode that followed a depressive episode.Two weeks after his valproate dose was increased to2000mg [initial dose not stated; frequency not stated], hedeveloped urinary incontinence and disoriented behaviour.Of note, he developed hyperammonaemic encephalopathy6 weeks after valproate initiation.
Valproate was withdrawn for suspected toxicity. Thepatient’s arterial ammonia level was 150 mmol/L. He gotbetter, and his serum ammonia decreased to 35 mmol/L.His carbamazepine dose was increased from 400mg to800 mg/day for symptom control [indication not clearlystated]. Olanzapine was started as well. His serum sodiumlevel, which was initially normal, was less than 125 mEq/L[duration of treatment to reaction onset not stated] due tocarbamazepine. He was diagnosed with SIADH due tocarbamazepine. His carbamazepine dose was reduced to400mg as before, and his urine sodium level got corrected.Lithium was started for behaviour control. Of note, he wassuspected of having an undiagnosed urea cycle disorder.
Author comment: "[The patient] had hyperammonemicencephalopathy 6 weeks following valproate initiation [andhad] hyponatraemia due to carbamazepine."Ajeesh PR, et al. A case of bipolar disorder with hyerammonemia due to valproateand hyponatremia due to carbamazepine. Indian Journal of Psychiatry 53 (Suppl.1): 74, No. 5, Apr 2011 [abstract] - India 803073405
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Reactions 21 Jul 2012 No. 14110114-9954/10/1411-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
