1989 Volume 7 Issue 1 Pages 89-95
Blood ammonia levels were examined in 300 patients (range: 0-24 years old) receiving antiepileptic drugs (AEDs). Hyperammonia (ammonia level over than 86.0 μg/ml/ by enzymatic method) was found in 66 cases (22.0%), 33 males and 33 females. As 65 out of 66 hyperammonemic patients on AED were given VPA and their blood ammonia levels returned to normal after VPA withdrawal, almost hyperammonemia on AED might be induced by VPA. he mean serum VPA levels in patients with hyperammonemia was 66.7±22.5μg/ml, but there was no relationships between serum VPA levels and blood ammonia levels of patients with hyperammonemia. The maximum ammonia level (446.3μg/ml) was found in multiply handicapped 13 years old girl who was sufferring from erythema infectiosum followed by acute evidence of repetitive convulsions and lethargy. After withdrawal of VPA, convulsions were controlled within a day, and also her physical and conscious state recovered to the former level within 2 days. Alternations in the state of consciusness, increased epileptic seizures, poor activity and vomiting were main manifes-tations of patients with hyperammonemia. Comparision of motor function of 65 hyperammonemic patients with that of 129 normoammonemic patients on VPA showed that diminished daily activity had probably promoted hyperammonemia. The mean number of AED in hyperammonemic patients was 3.4±11.2 and in normoammonemic patients was 2.3±1.0. In 15 patients with hyperammonemia, there was previous symptoms that was highly suggestive of respiratory truct infection. In conclusion, almost hyperammonemia on AED might be induced by VPA and polypharmacy, respiratory truct infections, lack of daily activity and malnutrition pro-bably trigger hyperammonemia. We recommended regular check of blood ammonia levels in patient receiving VPA. And also we recommended emergency check of bloo ammonia level when we foud out the symptoms after increasing of VPA.
