Does Depakote cause hyperammonemia?
The use of valproic acid (VPA) (also known as Depakote, Depakene, and others) frequently results in elevated plasma ammonia. In some people, hyperammonemia may be clinically significant, resulting in hyperammonemic encephalopathy, which may be severe.
Why does Depakote increase ammonia?
The mechanism is decreased production of mitochondrial acetyl CoA, which causes decrease in N -acetylglutamate, an activator of carbamoyl phosphate synthetase. Thus, patients with partial enzyme deficiencies may be at increased risk of developing symptomatic hyperammonemia during treatment with valproate.
What are the types of hyperammonemia?
Isovaleric acidemia. Propionic acidemia. Carnitine palmitoyltransferase II deficiency. Transient hyperammonemia of the newborn, specifically in the preterm.
Do you treat asymptomatic hyperammonemia?
Valproic acid (VPA)–induced hyperammonemia poses several clinical challenges in psychiatric medicine. The reported incidence of this adverse effect varies widely across the literature. Furthermore, practitioners treat hyperammonemia in asymptomatic patients although studies suggest this practice is unnecessary.
What are good Depakote levels?
The therapeutic range for valproic acid (free) is 6-22 µg/mL. The toxic level is greater than 50 µg/mL; above this threshold concentration, the binding sites on plasma albumin begin to become saturated. The recommended range for the treatment of epilepsy is 50-100 µg/mL total valproic acid.
What is Type 2 hyperammonemia?
Abstract. Ornithine transcarbamylase deficiency is the most common inherited urea cycle disorder. Its clinical manifestations as lethargy, vomites, coma and cerebral edema are the effect of the higher concentration of the ammonia in plasma.
How is hyperammonemia diagnosed?
Perform the following tests in patients with suspected hyperammonemia:
- Arterial blood gas analysis.
- Serum amino acid levels.
- Urinary orotic acid levels.
- Urinary ketone tests.
- Plasma and urinary organic acid levels.
- Enzyme assays.
- DNA mutation analysis: Method of choice to confirm the diagnosis of urea cycle disorders.
How long is Depakote in your system?
The highest level of medicine in the blood is reached in 7 to 14 hours after Depakote ER is taken. The highest levels are not as high as with regular Depakote, and the lowest levels are not as low. This difference may reduce side effects at the highest levels and improve seizure control when the levels are lowest.
Does hyperammonemia cause acidosis?
Hyperammonemia is mild in arginase deficiency, and the associated neuronal damage is due to elevated levels of arginine. Other enzymatic defects causing hyperammonemia are associated with additional metabolic abnormalities. Ketosis and acidosis are associated with organic acidemias such as isovaleric acidemia.