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Jerome V. Murphy, MD

Arch Neurol. 1982;39(9):591-592.

Abstract
• To determine the frequency of hyperammonemia in asymptomatic patients receiving valproic acid, plasma ammonia concentrations were measured in 55 patients receiving this drug and in 12 patients receiving other anticonvulsants. Twenty-nine of the 55 patients receiving valproic acid and none of the control patients had plasma NH₃ levels above the normal range. Ten of the 11 patients receiving both valproic acid and phenytoin sodium in combination had elevated NH₃ levels, as did five of six patients receiving both valproic acid and phenobarbital sodium. Elevations in plasma NH₃ levels, as high as 140 µmole/L, were well tolerated, and valproic acid dose reductions were not necessary. Based on our findings, hyperammonemia is not an indication for reducing or eliminating valproic acid therapy.

Author Affiliations
Kathleen Marquardt

From the Department of Pediatrics, Medical College of Wisconsin, and Milwaukee Pediatric Neurology.

Footnotes
Accepted for publication Dec 11, 1981.

Reprint requests to Milwaukee Pediatric Neurology, 2040 W Wisconsin Ave, Suite 702, Milwaukee, WI 53233 (Dr Murphy).

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