Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0042963 (vomiting)
 31,883 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

An infant presented with global developmental delay and infantile spasms. EEG was suggestive of hypsarrhythmia. She was started on sodium valproate, clonazepam and adrenocorticotropic hormone injection. After an initial improvement the child developed vomiting, altered sensorium and increase in frequency of seizures suggestive of encephalopathy. Valproate-induced hyperammonaemia or hepatic encephalopathy was considered and the drug was withheld following which there was a dramatic improvement. Paradoxically, the liver function tests and serum ammonia were normal. However, a complete reversal of encephalopathy, on withdrawal of the drug, strongly suggested an adverse drug reaction (ADR) due to valproic acid. Marginal elevation of serum valproic acid prompted us to use the Naranjo ADR probability score to confirm the diagnosis. This case highlights the fact that valproate toxicity can manifest with normal liver function and serum ammonia levels. This is the youngest reported case with this rare form of valproate-induced encephalopathy.
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PMID:Encephalopathy in an infant with infantile spasms: possible role of valproate toxicity. 2481 Apr 46

Valproic acid (VPA) is approved by the Food and Drug Administration (FDA) for the treatment of manic or mixed episodes associated with bipolar disorder. VPA is also used off-label to treat other conditions in psychiatry such as impulse control disorders, major depression, and posttraumatic stress disorder (PTSD). Although VPA is mostly well-tolerated, common adverse effects include gastrointestinal symptoms (nausea, vomiting, diarrhea), neurological symptoms (sedation, ataxia, tremor), weight gain, and alopecia. Less common adverse effects include VPA-induced parkinsonism and cognitive impairment. We describe a patient who developed parkinsonism and cognitive impairment eight years after starting divalproex sodium for bipolar disorder, type I. Over time, the patient's parkinsonian symptoms progressed, and the motor symptoms were partially responsive to carbidopa/levodopa. Her mild cognitive impairment was, for the most part, stable on donepezil. Rapid discontinuation of divalproex sodium resolved the parkinsonian symptoms as well as the cognitive impairment. A brief review of the literature regarding VPA-induced parkinsonism and cognitive impairment in adults is included. Given the reversible nature and potential severity of VPA-induced parkinsonism, improved recognition in psychiatric populations is critical, particularly after extended VPA exposure. To the best of our knowledge there are no reports describing the onset of VPA-induced parkinsonism in psychiatric patients more than eight years after starting VPA.
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PMID:Reversible Valproic Acid-Induced Parkinsonism and Cognitive Impairment in an Elderly Patient With Bipolar Disorder I. 2771 42


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