Question
A patient on a mood stabilizer has developed hyperammonemia and hepatitis/raised hepatic enzymes. Which of the following is likely to be responsible?
| A. |
Lithium
|
| B. |
Valproate
|
| C. |
Carbamazepine
|
| D. |
Topiramate
|
Show Answer
|
Correct Answer � B
Explanation
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Valproate and Its Side Effects:
Valproate(also known as valproic acid) is a commonly used mood stabilizer, particularly in bipolar disorder. However, it is associated with significant side effects, including:
- Hyperammonemia: Valproate can disrupt the urea cycle, leading to an accumulation of ammonia in the blood, causing hyperammonemia. This can result in symptoms like lethargy, confusion, and encephalopathy.
- Hepatotoxicity: Valproate is known to cause hepatitis and elevated liver enzymes. The risk of hepatotoxicity is particularly high in young children and people with pre-existing liver conditions, but it can occur in adults as well.
- Other side effects: Weight gain, tremor, hair loss, and gastrointestinal disturbances.
Other Options:
Lithium: Lithium can cause renal and thyroid dysfunction.
Carbamazepine: Carbamazepine can cause hepatic enzyme elevation but is not known to cause hyperammonemia. Its side effects are more often related to hematologic issues (e.g., aplastic anemia) and CNS toxicity.
Topiramate: Topiramate is primarily associated with metabolic acidosis, cognitive side effects, and weight loss.
