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Valproate-associated carnitine deficiency and malignant cerebral edema in the absence of hepatic failure.

Publication ,  Journal Article
Triggs, WJ; Gilmore, RL; Millington, DS; Cibula, J; Bunch, TS; Harman, E
Published in: Int J Clin Pharmacol Ther
September 1997

We describe a 27-year-old woman who developed encephalopathy and cerebral edema during treatment of refractory complex partial seizures that included acute administration of valproate (VPA) at a dosage of 35 mg/kg per day. Multiple random VPA levels were within therapeutic range, and results of liver function studies did not show evidence of hepatic failure. Cerebral computerized tomography (CT) showed evidence of massive cerebral edema with central herniation. Just prior to death, plasma levels of free and acyl carnitines were markedly decreased. Analysis of urinary organic acids showed increased excretion of lactate, but a normal distribution of VPA metabolites. Carnitine deficiency may predispose patients to the development of coma and life-threatening cerebral edema associated with acute administration of VPA, even in the absence of concomitant hepatic failure. We suggest specific guidelines for the evaluation and management of altered consciousness in patients with seizures receiving VPA.

Duke Scholars

Published In

Int J Clin Pharmacol Ther

ISSN

0946-1965

Publication Date

September 1997

Volume

35

Issue

9

Start / End Page

353 / 356

Location

Germany

Related Subject Headings

  • Valproic Acid
  • Pharmacology & Pharmacy
  • Humans
  • Female
  • Fatal Outcome
  • Epilepsy, Complex Partial
  • Carnitine
  • Brain Edema
  • Anticonvulsants
  • Adult
 

Citation

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Triggs, W. J., Gilmore, R. L., Millington, D. S., Cibula, J., Bunch, T. S., & Harman, E. (1997). Valproate-associated carnitine deficiency and malignant cerebral edema in the absence of hepatic failure. Int J Clin Pharmacol Ther, 35(9), 353–356.
Triggs, W. J., R. L. Gilmore, D. S. Millington, J. Cibula, T. S. Bunch, and E. Harman. “Valproate-associated carnitine deficiency and malignant cerebral edema in the absence of hepatic failure.Int J Clin Pharmacol Ther 35, no. 9 (September 1997): 353–56.
Triggs WJ, Gilmore RL, Millington DS, Cibula J, Bunch TS, Harman E. Valproate-associated carnitine deficiency and malignant cerebral edema in the absence of hepatic failure. Int J Clin Pharmacol Ther. 1997 Sep;35(9):353–6.
Triggs, W. J., et al. “Valproate-associated carnitine deficiency and malignant cerebral edema in the absence of hepatic failure.Int J Clin Pharmacol Ther, vol. 35, no. 9, Sept. 1997, pp. 353–56.
Triggs WJ, Gilmore RL, Millington DS, Cibula J, Bunch TS, Harman E. Valproate-associated carnitine deficiency and malignant cerebral edema in the absence of hepatic failure. Int J Clin Pharmacol Ther. 1997 Sep;35(9):353–356.

Published In

Int J Clin Pharmacol Ther

ISSN

0946-1965

Publication Date

September 1997

Volume

35

Issue

9

Start / End Page

353 / 356

Location

Germany

Related Subject Headings

  • Valproic Acid
  • Pharmacology & Pharmacy
  • Humans
  • Female
  • Fatal Outcome
  • Epilepsy, Complex Partial
  • Carnitine
  • Brain Edema
  • Anticonvulsants
  • Adult