丙戊酸钠相关高血氨脑病1例报告及文献回顾  

Sodium valproate-induced hyperammonemic encephalopathy:a case report and literature review

作　　者：刘宇[1] 张媛媛[1] 吴亦美[1] 赵秀丽[1] 张小澍[1] 

机构地区：[1]解放军第261医院神经内科,北京100094

出　　处：《药物不良反应杂志》2009年第3期203-205,共3页Adverse Drug Reactions Journal

摘　　要：患者男,18岁,因患癫痫用卡马西平治疗3个月疗效欠佳,改用丙戊酸钠0.2 g/d治疗40余天。之后,患者突然出现四肢抽搐、意识丧失收入院。经抢救意识恢复,患者述眩晕、复视、恶心、呕吐、耳鸣。检查:构音障碍、眼球震颤、共济失调等症状。入院第4天,患者血氨为117.6μmol/L,血常规、肝、肾功能检测均正常,头颅MRI未见明显异常。停用丙戊酸钠后症状好转,再次服用该药,再次出现头晕。立即停用丙戊酸钠,改用氯硝西泮治疗后症状消失,血氨降至66μmol/L。An 18-year-old man with epilepsy received carbamazepine treatment for 3 months, but no effects were observed, then carbamazepine was changed to sodium valproate 0.2 g daily for 40 days and more. Subsequently, the patient suddenly developed convulsion on limbs with uneonsciousness, then he was hospitalized. His consciousness recovered after management. He presented with dizziness, diplopia, nausea, vomiting, and tinnitus. Examination revealed dysarthria, nystagmus and ataxia. On day four after admission, his blood ammonia level was 117.6 μmol/L. Routine blood testing and liver and renal function examination were normal. A brain MRI found no marked abnormalities. His symptoms improved after discontinuation of sodium valproate and his dizziness recurrecl after readministration of sodium valproate. Sodium valproate was stopped immediately and switched to ehmazepam. His symptoms disappeared. His blood ammonia level decreased to 66 μmol/L.

关 键 词：丙戊酸钠 不良反应 高血氨症 脑病 

分 类 号：R595.3[医药卫生—内科学]