Hyperammonemic encephalopathy secondary to chronic Valproicacid overdose

Hyperammonemic encephalopathy secondary to Valproate therapy is an uncommon adverse affect. We had a 70year old female, known case of epilepsy on sodium Valproate form 3 years presented with drowsiness, slurring of speech. Investigations were done Magnetic resonance imagingBrain and Liver Function Tests were normal, Serum Valproate and Serum Ammonia levels were increased. Valproate was withdrawn and patient was started on L – Carnitine. Serum Ammonia levels decreased and patient symptoms subsided. Hyperammoneic Encephalopathy should be suspected in patients on Valproate presenting with Encephalopathy symptom