丙戊酸钠致高氨血症1例

Hyperammonemia caused by sodium valproate:a case report

回顾性分析合肥市第一人民医院重症医学科ICU收治的1例复杂高氨血症老年患者的临床资料并进行总结。患者因脑外伤伴癫痫发作收住入院,既往有胆管癌伴肝转移病史,入院后予丙戊酸钠控制癫痫发作,病程中患者肺部感染严重,肝功能正常,血氨升高,加用苯巴比妥肌内注射联合丙戊酸钠缓释片口服后出现血氨迅速升高。停用抗癫痫药物后,患者血氨逐步降至正常。高氨血症的病因不易鉴别,尤其是丙戊酸钠引起的非肝硬化性高氨血症临床不常见,在诊疗工作中需高度重视,避免漏诊、误诊。

To study the clinical diagnosis and treatment characteristics of sodium valproate-related hyperammonemia.To retrospectively analyze and summarize the clinical data of an elderly patient with complex hyperammonemia in ICU of our hospital.Thepatient was admitted to the hospital due to brain trauma and seizures.He had a history of cholangiocarcinoma with liver metastasis.After admission,sodium valproate was used to control the seizures.During the course of the disease,the patient had severe lung infection,normal liver function,and elevated blood ammonia.After oral administration of phenobarbital combined with sodium valproate sustained-release tablets,blood ammonia rapidly increased.After stopping the antiepileptic drugs,the patient’s blood ammonia gradually decreased to normal.The etiology of hyperammonemia is not easy to identify,especially non-hepatic hyperammonemiacaused by sodium valproate is not common in clinical practice.It is necessary to attach great importance to clinical diagnosis and treatment to avoid missed diagnosis and misdiagnosis.