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Hepatic encephalopathy precipitated by sodium valproate therapy

H S Subhash, Robert J Heddle, David W Schultz, John Ring and Campbell H Thompson
Med J Aust 2008; 188 (9): 549.

To the Editor: We report the case of a 71-year-old woman who presented with a 3-week history of lethargy, subacute confusion and drowsiness. She was known to have a seizure disorder for which she had been taking lamotrigine 100 mg and sodium valproate 500 mg twice a day for 2 years.

H S Subhash, Registrar1
Robert J Heddle, Director of Allergy, Department of Respiratory Medicine,1 and Associate Professor2
David W Schultz, Senior Lecturer, Division of Neurology3
John Ring, Senior Consultant, Division of Gastroenterology and Hepatology3
Campbell H Thompson, Professor, Division of Medicine3
1 Division of Medicine, Flinders Medical Centre, Adelaide, SA.
2 Flinders University, Adelaide, SA.
3 Flinders Medical Centre and Flinders University, Adelaide, SA.
Article References: 
Reference Text: 
DeVane CL. Pharmacokinetics, drug interactions, and tolerability of valproate. Psychopharmacol Bull 2003; 37 Suppl 2: 25-42.
Reference Order: 
1
Reference Text: 
Segura-Bruna N, Rodriguez-Campello A, Puente V, Roquer J. Valproate-induced hyperammonemic encephalopathy. Acta Neurol Scand 2006; 114: 1-7.
Reference Order: 
2
PubMed ID: 
16774619
Reference Link: 
0_i1091842
Reference Text: 
Gomceli YB, Kutlu G, Cavdar L, et al. Different clinical manifestations of hyperammonemic encephalopathy. Epilepsy Behav 2007; 10: 583-587.
Reference Order: 
3
PubMed ID: 
17412645
Reference Link: 
0_i1091844
Reference Text: 
Gerstner T, Buesing D, Longin E, et al. Valproic acid induced encephalopathy — 19 new cases in Germany from 1994 to 2003 — a side effect associated to VAP-therapy not only in young children. Seizure 2006; 15: 443-448.
Reference Order: 
4
PubMed ID: 
16787750
Reference Link: 
0_i1091846
Reference Text: 
Beyenburg S, Back C, Diederich N, et al. Is valproate encephalopathy under-recognised in older people? A case series. Age Ageing 2007; 36: 344-346.
Reference Order: 
5
PubMed ID: 
17374600
Reference Link: 
0_i1091848

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