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Answer and interpretation This is probably valproic acid induced hyperammonia encephalopathy (VHE) VHE has been reported secondary to acute VPA overdose and in chronic normal therapeutic dosing, presenting as an acute and profound decreased level of consciousness, with or without increased seizure activity this is usually in association with an increased serum ammonia level (Mock and Schwetschenau, 2008) Patients at higher risk for VHE include those with liver impairment, on multiple anticonvulsants, or have other causes of increased ammonia production

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if it appeared in the adult, did it arise rapidly

Contact our Pharmacy Department Additional pharmacy resources The New Jersey state specific Clinical Criteria for injectable, infused, or implanted prescription drugs and therapies covered under the medical benefit are available for the Medicaid market

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Additionally, consider lifestyle choices that support glutathione production, such as regular exercise and minimizing exposure to environmental toxins