{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T20:21:11Z","timestamp":1787257271936,"version":"build-2736575974"},"reference-count":20,"publisher":"American Association of Psychiatric Pharmacists (AAPP)","issue":"4","license":[{"start":{"date-parts":[[2021,7,16]],"date-time":"2021-07-16T00:00:00Z","timestamp":1626393600000},"content-version":"vor","delay-in-days":15,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/3.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,7,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Valproic acid (VPA) is widely used for the treatment of epilepsy, migraine, and a variety of psychiatric conditions. The reported incidences of hyperammonemia induced by VPA use is variable. The purpose of this study is to evaluate the incidence of VPA-induced hyperammonemia in the general adult inpatient population.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Adult patients who received at least 1 dose of VPA and derivatives between June 1, 2017 to December 31, 2017 were included. Patients were excluded if they did not have VPA administered during their inpatient stay or if they had elevated ammonia levels (&amp;gt;33 \u03bcmol\/L) prior to initiation of VPA. Patients with a confirmed diagnosis of liver cirrhosis were also excluded. The primary endpoint was the incidence of hyperammonemia. Secondary outcomes included symptoms of hyperammonemia, diagnosis of VPA-induced hyperammonemia, and treatment of VPA-induced hyperammonemia.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>A total of 162 patients were included in this study. A total of 33 (20.4%) patients were identified as having the primary outcome of hyperammonemia; 26 (16.0%) patients had symptoms of hyperammonemia, and 13 (8.0%) patients were diagnosed with VPA-induced hyperammonemia. Treatment modalities included administration of lactulose, levocarnitine, discontinuing VPA, or decreasing the VPA dose.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Discussion<\/jats:title>\n                  <jats:p>The administration of VPA in the general adult inpatient population resulted in a 20.4% incidence of hyperammonemia, with a lower rate of diagnosed VPA-induced hyperammonemia. Clinicians should be encouraged to obtain ammonia levels in patients receiving VPA if symptoms of altered mental status or encephalopathy develop.<\/jats:p>\n               <\/jats:sec>","DOI":"10.9740\/mhc.2021.07.243","type":"journal-article","created":{"date-parts":[[2021,7,16]],"date-time":"2021-07-16T17:41:38Z","timestamp":1626457298000},"page":"243-247","source":"Crossref","is-referenced-by-count":7,"title":["Hyperammonemia in patients receiving valproic acid in the hospital setting: A retrospective review"],"prefix":"10.9740","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1727-9680","authenticated-orcid":true,"given":"Tressa","family":"McMorris","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2949-0552","authenticated-orcid":true,"given":"Angela","family":"Chu","sequence":"additional","affiliation":[{"name":"Assistant Professor of Pharmacy Practice, College of Pharmacy, Roseman University of Health Sciences, South Jordan, Utah"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4014-6146","authenticated-orcid":true,"given":"Lynn","family":"Vu","sequence":"additional","affiliation":[{"name":"Pharmacist, CVS Pharmacy, Tuscon, Arizona; previously: Roseman University of Health Sciences College of Pharmacy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5273-3754","authenticated-orcid":true,"given":"Amanda","family":"Bernardini","sequence":"additional","affiliation":[{"name":"Pharmacist, Raley's Pharmacy, Reno, Nevada; previously: Roseman University of Health Sciences College of Pharmacy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"4719","published-online":{"date-parts":[[2021,7,16]]},"reference":[{"key":"2021071617405539400_i2168-9709-11-4-243-b01","doi-asserted-by":"crossref","unstructured":"Aiyer\n              R,\n            \n            \n              Seide\n              M,\n            \n            \n              Stern\n              RG.\n            \n          \n          Valproic acid induced hyperammonemia in a long time treated patient.\n\t\t\t\t\tCase Rep Psychiatry.\n\t\t\t\t\t2016;\n\t\t\t\t\t2016:\n\t\t\t\t\t6242314.\n\t\t\t\t\tDOI: 10.1155\/2016\/6242314. PubMed PMID: 27516916; PubMed Central PMCID: PMC4969522.","DOI":"10.1155\/2016\/6242314"},{"key":"2021071617405539400_i2168-9709-11-4-243-b02","doi-asserted-by":"crossref","unstructured":"Carr\n              RB,\n            \n            \n              Shrewsbury\n              K.\n            \n          \n          Hyperammonemia due to valproic acid in the psychiatric setting.\n\t\t\t\t\tAm J Psychiatry.\n\t\t\t\t\t2007;\n\t\t\t\t\t164(7):\n\t\t\t\t\t1020-\n\t\t\t\t\t7.\n\t\t\t\t\tDOI: 10.1176\/ajp.2007.164.7.1020. PubMed PMID: 17606652.","DOI":"10.1176\/ajp.2007.164.7.1020"},{"key":"2021071617405539400_i2168-9709-11-4-243-b03","doi-asserted-by":"crossref","unstructured":"Dixit\n              S,\n            \n            \n              Namdeo\n              M,\n            \n            \n              Azad\n              S.\n            \n          \n          Valproate induced delirium due to hyperammonemia in a case of acute mania.\n\t\t\t\t\tJ Clin Diagn Res.2015;\n\t\t\t\t\t9(4):\n\t\t\t\t\tVD01-2.DOI: 10.7860\/JCDR\/2015\/11830.5758. PubMed PMID: 26023626.","DOI":"10.7860\/JCDR\/2015\/11830.5758"},{"key":"2021071617405539400_i2168-9709-11-4-243-b04","doi-asserted-by":"crossref","unstructured":"Lee\n              S,\n            \n            \n              Cheong\n              J,\n            \n            \n              Kim\n              C,\n            \n            \n              Kim\n              JM.\n            \n          \n          Valproic acid-induced hyperammonemic encephalopathy as a cause of neurologic deterioration after unruptured aneurysm surgery.\n\t\t\t\t\tJ Korean Neurosurg Soc.\n\t\t\t\t\t2015;\n\t\t\t\t\t58(2):\n\t\t\t\t\t159-\n\t\t\t\t\t62.\n\t\t\t\t\tDOI: 10.3340\/jkns.2015.58.2.159. PubMed PMID: 26361536; PubMed Central PMCID: PMC4564752.","DOI":"10.3340\/jkns.2015.58.2.159"},{"key":"2021071617405539400_i2168-9709-11-4-243-b05","doi-asserted-by":"crossref","unstructured":"Shah\n              S,\n            \n            \n              Wang\n              R,\n            \n            \n              Vieux\n              U.\n            \n          \n          Valproate-induced hyperammonemic encephalopathy: a case report.\n\t\t\t\t\tJ Med Case Rep.\n\t\t\t\t\t2020;\n\t\t\t\t\t14(1):\n\t\t\t\t\t19.\n\t\t\t\t\tDOI: 10.1186\/s13256-020-2343-x. PubMed PMID: 31980035; PubMed Central PMCID: PMC6982381.","DOI":"10.1186\/s13256-020-2343-x"},{"key":"2021071617405539400_i2168-9709-11-4-243-b06","doi-asserted-by":"crossref","unstructured":"Wu\n              M-Y,\n            \n            \n              Chang\n              F-Y,\n            \n            \n              Ke\n              J-Y,\n            \n            \n              Chen\n              C-S,\n            \n            \n              Lin\n              P-C,\n            \n            \n              Wang\n              T-S.\n            \n          \n          Valproic acid-induced hyperammonemic encephalopathy in a patient with bipolar disorder: a case report.\n\t\t\t\t\tBrain Sci.\n\t\t\t\t\t2020;\n\t\t\t\t\t10(3):\n\t\t\t\t\t187.\n\t\t\t\t\tDOI: 10.3390\/brainsci10030187. PubMed PMID: 32213827; PubMed Central PMCID: PMC7139302.","DOI":"10.3390\/brainsci10030187"},{"key":"2021071617405539400_i2168-9709-11-4-243-b07","doi-asserted-by":"crossref","unstructured":"Lin\n              M-W,\n            \n            \n              Chang\n              C,\n            \n            \n              Yeh\n              C-B,\n            \n            \n              Tai\n              Y-M,\n            \n            \n              Chang\n              H-A,\n            \n            \n              Kao\n              Y-C,\n            \n            et al.\n          \n          Aripiprazole-related hyponatremia and consequent valproic acid-related hyperammonemia in one patient.\n\t\t\t\t\tAust N Z J Psychiatry.\n\t\t\t\t\t2017;\n\t\t\t\t\t51(3):\n\t\t\t\t\t296-\n\t\t\t\t\t7.\n\t\t\t\t\tDOI: 10.1177\/0004867416671416. PubMed PMID: 27694641.","DOI":"10.1177\/0004867416671416"},{"key":"2021071617405539400_i2168-9709-11-4-243-b08","doi-asserted-by":"crossref","unstructured":"Gayam\n              V,\n            \n            \n              Mandal\n              AK,\n            \n            \n              Khalid\n              M,\n            \n            \n              Shrestha\n              B,\n            \n            \n              Garlapati\n              P,\n            \n            \n              Khalid\n              M.\n            \n          \n          Valproic acid induced acute liver injury resulting in hepatic encephalopathy - a case report and literature review.\n\t\t\t\t\tJ Community Hosp Intern Med Perspect.\n\t\t\t\t\t2018;\n\t\t\t\t\t8(5):\n\t\t\t\t\t311-\n\t\t\t\t\t4.\n\t\t\t\t\tDOI: 10.1080\/20009666.2018.1514933. PubMed PMID: 30356994; PubMed Central PMCID: PMC6197012.","DOI":"10.1080\/20009666.2018.1514933"},{"key":"2021071617405539400_i2168-9709-11-4-243-b09","doi-asserted-by":"crossref","unstructured":"Taneja\n              V,\n            \n            \n              Jasuja\n              H.\n            \n          \n          Severe hyperammonemia from intense skeletal muscle activity: a rare case report and literature review.\n\t\t\t\t\tMedicine (Baltimore).\n\t\t\t\t\t2019;\n\t\t\t\t\t98(47):\n\t\t\t\t\te17981.\n\t\t\t\t\tDOI: 10.1097\/MD.0000000000017981. PubMed PMID: 31764807.","DOI":"10.1097\/MD.0000000000017981"},{"key":"2021071617405539400_i2168-9709-11-4-243-b10","doi-asserted-by":"crossref","unstructured":"Baumgartner\n              J,\n            \n            \n              Hoeflich\n              A,\n            \n            \n              Hinterbuchinger\n              B,\n            \n            \n              Fellinger\n              M,\n            \n            \n              Graf\n              I,\n            \n            \n              Friedrich\n              F,\n            \n            et al.\n          \n          Fulminant onset of valproate-associated hyperammonemic encephalopathy.\n\t\t\t\t\tAm J Psychiatry.\n\t\t\t\t\t2019;\n\t\t\t\t\t176(11):\n\t\t\t\t\t900-\n\t\t\t\t\t3.\n\t\t\t\t\tDOI: 10.1176\/appi.ajp.2019.18040363. PubMed PMID: 31672038.","DOI":"10.1176\/appi.ajp.2019.18040363"},{"key":"2021071617405539400_i2168-9709-11-4-243-b11","doi-asserted-by":"crossref","unstructured":"Mehta\n              S,\n            \n            \n              Tayabali\n              S,\n            \n            \n              Lachmann\n              R.\n            \n          \n          Valproate-induced hyperammonemia - uncovering an underlying inherited metabolic disorder: a case report.\n\t\t\t\t\tJ Med Case Rep.\n\t\t\t\t\t2018;\n\t\t\t\t\t12(1):\n\t\t\t\t\t134.\n\t\t\t\t\tDOI: 10.1186\/s13256-018-1666-3. PubMed PMID: 29769109.","DOI":"10.1186\/s13256-018-1666-3"},{"key":"2021071617405539400_i2168-9709-11-4-243-b12","doi-asserted-by":"crossref","unstructured":"Gandolfo\n              F,\n            \n            \n              Parodi\n              MN,\n            \n            \n              Corsini\n              GP,\n            \n            \n              Odetti\n              P,\n            \n            \n              Serafini\n              G,\n            \n            \n              Monacelli\n              F.\n            \n          \n          Valproate-induced encephalopathy in a comorbid elderly woman.\n\t\t\t\t\tPsychogeriatrics.\n\t\t\t\t\t2017;\n\t\t\t\t\t17(3):\n\t\t\t\t\t208-\n\t\t\t\t\t9.\n\t\t\t\t\tDOI: 10.1111\/psyg.12215. PubMed PMID: 28093879.","DOI":"10.1111\/psyg.12215"},{"key":"2021071617405539400_i2168-9709-11-4-243-b13","doi-asserted-by":"crossref","unstructured":"Ando\n              M,\n            \n            \n              Amayasu\n              H,\n            \n            \n              Itai\n              T,\n            \n            \n              Yoshida\n              H.\n            \n          \n          Association between the blood concentrations of ammonia and carnitine\/amino acid of schizophrenic patients treated with valproic acid.\n\t\t\t\t\tBiopsychosoc Med.\n\t\t\t\t\t2017;\n\t\t\t\t\t11:\n\t\t\t\t\t19.\n\t\t\t\t\tDOI: 10.1186\/s13030-017-0101-0. PubMed PMID: 28690671.","DOI":"10.1186\/s13030-017-0101-0"},{"key":"2021071617405539400_i2168-9709-11-4-243-b14","doi-asserted-by":"crossref","unstructured":"Nanau\n              RM,\n            \n            \n              Neuman\n              MG.\n            \n          \n          Adverse drug reactions induced by valproic acid.\n\t\t\t\t\tClin Biochem.\n\t\t\t\t\t2013;\n\t\t\t\t\t46(15):\n\t\t\t\t\t1323-\n\t\t\t\t\t38.\n\t\t\t\t\tDOI: 10.1016\/j.clinbiochem.2013.06.012. PubMed PMID: 23792104.","DOI":"10.1016\/j.clinbiochem.2013.06.012"},{"key":"2021071617405539400_i2168-9709-11-4-243-b15","doi-asserted-by":"crossref","unstructured":"Mock\n              CM,\n            \n            \n              Schwetschenau\n              KH.\n            \n          \n          Levocarnitine for valproic-acid-induced hyperammonemic encephalopathy.\n\t\t\t\t\tAm J Health Syst Pharm.\n\t\t\t\t\t2012;\n\t\t\t\t\t69(1):\n\t\t\t\t\t35-\n\t\t\t\t\t9.\n\t\t\t\t\tDOI: 10.2146\/ajhp110049. PubMed PMID: 22180549.","DOI":"10.2146\/ajhp110049"},{"key":"2021071617405539400_i2168-9709-11-4-243-b16","doi-asserted-by":"crossref","unstructured":"Duman\n              B,\n            \n            \n              Can\n              KC,\n            \n            \n              A\u011fta\u015f-Ertan\n              E,\n            \n            \n              Erdo\u011fan\n              S,\n            \n            \n              \u0130lhan\n              RS,\n            \n            \n              Do\u011fan\n              \u00d6,\n            \n            et al.\n          \n          Risk factors for valproic acid induced hyperammonemia and its association with cognitive functions.\n\t\t\t\t\tGen Hosp Psychiatry.\n\t\t\t\t\t2019;\n\t\t\t\t\t59:\n\t\t\t\t\t67-\n\t\t\t\t\t72.\n\t\t\t\t\tDOI: 10.1016\/j.genhosppsych.2019.05.005. PubMed PMID: 31276904.","DOI":"10.1016\/j.genhosppsych.2019.05.005"},{"key":"2021071617405539400_i2168-9709-11-4-243-b17","doi-asserted-by":"crossref","unstructured":"Baddour\n              E,\n            \n            \n              Tewksbury\n              A,\n            \n            \n              Stauner\n              N.\n            \n          \n          Valproic acid-induced hyperammonemia: Incidence, clinical significance, and treatment management.\n\t\t\t\t\tMent Health Clin [Internet].\n\t\t\t\t\t2018;\n\t\t\t\t\t8(2):\n\t\t\t\t\t73-\n\t\t\t\t\t7.\n\t\t\t\t\tDOI: 10.9740\/mhc.2018.03.073. PubMed PMID: 29955549; PubMed Central PMCID: PMC6007737.","DOI":"10.9740\/mhc.2018.03.073"},{"key":"2021071617405539400_i2168-9709-11-4-243-b18","doi-asserted-by":"crossref","unstructured":"Lewis\n              C,\n            \n            \n              Tesar\n              GE,\n            \n            \n              Dale\n              R.\n            \n          \n          Valproate-induced hyperammonemic encephalopathy in general hospital patients with one or more psychiatric disorders.\n\t\t\t\t\tPsychosomatics.\n\t\t\t\t\t2017;\n\t\t\t\t\t58(4):\n\t\t\t\t\t415-\n\t\t\t\t\t20.\n\t\t\t\t\tDOI: 10.1016\/j.psym.2017.02.003. PubMed PMID: 28411969.","DOI":"10.1016\/j.psym.2017.02.003"},{"key":"2021071617405539400_i2168-9709-11-4-243-b19","doi-asserted-by":"crossref","unstructured":"Lind\n              J,\n            \n            \n              Nordlund\n              P.\n            \n          \n          Intravenous use of valproic acid in status epilepticus is associated with high risk of hyperammonemia.\n\t\t\t\t\tSeizure.\n\t\t\t\t\t2019;\n\t\t\t\t\t69(Suppl 6):\n\t\t\t\t\t20-\n\t\t\t\t\t4.\n\t\t\t\t\tDOI: 10.1016\/j.seizure.2019.03.020. PubMed PMID: 30953957.","DOI":"10.1016\/j.seizure.2019.03.020"},{"key":"2021071617405539400_i2168-9709-11-4-243-b20","doi-asserted-by":"crossref","unstructured":"Tseng\n              Y-L,\n            \n            \n              Huang\n              C-R,\n            \n            \n              Lin\n              C-H,\n            \n            \n              Lu\n              Y-T,\n            \n            \n              Lu\n              C-H,\n            \n            \n              Chen\n              N-C,\n            \n            et al.\n          \n          Risk factors of hyperammonemia in patients with epilepsy under valproic acid therapy.\n\t\t\t\t\tMedicine (Baltimore).\n\t\t\t\t\t2014;\n\t\t\t\t\t93(11):\n\t\t\t\t\te66.\n\t\t\t\t\tDOI: 10.1097\/MD.0000000000000066. PubMed PMID: 25192484; PubMed Central PMCID: PMC4616274.","DOI":"10.1097\/MD.0000000000000066"}],"container-title":["Mental Health Clinician"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/meridian.allenpress.com\/mhc\/article-pdf\/11\/4\/243\/2868673\/i2168-9709-11-4-243.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/meridian.allenpress.com\/mhc\/article-pdf\/11\/4\/243\/2868673\/i2168-9709-11-4-243.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,11,15]],"date-time":"2024-11-15T16:23:52Z","timestamp":1731687832000},"score":1,"resource":{"primary":{"URL":"https:\/\/mhc.kglmeridian.com\/view\/journals\/mhcl\/11\/4\/article-p243.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,7,1]]},"references-count":20,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2021,7,16]]},"published-print":{"date-parts":[[2021,7,1]]}},"URL":"https:\/\/doi.org\/10.9740\/mhc.2021.07.243","relation":{},"ISSN":["2168-9709"],"issn-type":[{"value":"2168-9709","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,7,1]]}}}