Hyperammonemia in patients on Valproic Acid therapy in a tertiary care hospital of Karachi

OBJECTIVE: to assess the incidence of hyperammonemia in patients receiving valproic acid (VPA) therapy. METHODS: This cross-sectional study was conducted at the Department of Neurology, Ziauddin Medical University and Hospital, Karachi, for six months from April to October 2019. A total of 158 patients of both genders, aged between 18 to 80 years, presented in emergency with complaints of seizures and who had received a minimum dose of valproic acid before blood withdrawal were included. Pregnant women, patients with cirrhotic liver, or chronic renal impairment were excluded from the study. RESULTS: Out of 158 patients, 80 (50.6%) were females and 78 (49.4%) were males. Mean age of patients was 55.53±18.26 years. Among the participants, 27 (17.1%) had undergone VPA therapy for 30 days or more, while 131 (82.9%) had received it for less than 30 days. The mean duration of VPA therapy was 8.58±10.41 days. Among the 158 patients, 95 (60.1%) with seizures receiving VPA treatment were diagnosed with hyperammonemia. The mean serum ammonia level was 66.50±44.59 mg/dL, and mean VPA dose administered was 1000±125 mg/day. There was a statistically significant association between the dose of Valproic Acid and the incidence of hyperammonemia (p