Search

Rationale: Valproic Acid is a commonly used psychiatric drug primarily used as a mood stabilizer. Mild hyperammonemia is a Valproic Acid common adverse effect. This report presents an example of treated hyperammonemia on Valproic acid therapy managed with L-carnitine administration in BD patients characterized by sudden vulnerability. Patient concerns: We report the case of a 29-year-old man suffering from bipolar disorder (BD) and substance use disorder who exhibited sudden altered mental status upon admittance to the inpatient unit. The patient was started on Valproic acid with no improvement. Diagnoses: The patient had remarkably high ammonia levels (594 μg/dL) without hepatic insufficiency, likely due to his valproate treatment. Interventions: The patient was administered lactulose, intravenous hydration, and i.v. levocarnitine supplementation 4.5 g/day. Outcomes: The administration leads to reduction of ammonia levels to 99 μg/dL within 12 hours upon initiation of carnitine therapy and progressive restore of his mental status within 24 hours. Lessons: Resolution of hyperammonemia caused by Valproic acid therapy may be enhanced with the administration of L-carnitine. An interesting aspect of this case was how rapidly the patient responded to the carnitine therapy.

The treatment with interferon-alpha is contraindicated in patients with major depression (National Institutes of Health), but a considerable number of neuropsychiatric side effects is associated with it: personality changes, impaired cognitive, mania, psychosis. In the literature limited reports of interferon-alpha-induced psychotic disorder exist. Authors report on a 46-year-old man diagnosed with alcohol induced psychotic disorder, who had been started to a treatment with Pegylated Interferon alfa-2b [Peg-Intron] and Ribavirin owing to a previous HCV-induced chronic hepatitis associated with a significant change in liver enzymes. During the first two months after the starting of therapy liver enzymes normalised, and modest side effects emerged, but the patient developed a psychotic reaction. Symptoms disappeared after discontinuation of interferon treatment.