Learn something new every day. ARGH! thank you apparently has hyperammonemia (he was admitted yet again last week), most likely the result of Depakote. Why on *earth* it's taken 11 years for this to happen is beyond me, especially since his doses have not been messed with in the last year or so and blood work has been done and normal up until last week (to my knowledge - I may need to start requesting copies of the actual results just to feel confident that they're staying on top of it and actually *reading* the reports - but hopefully a change in placement is in the tubes anyway because... well, anyway). Hyperammonemia (HA) has the potential to be very dangerous (coma). Found several references where it can be related to valproic acid (Depakote). I have a call in to psychiatrist - apparently they were confirming and rechecking ammonia levels (typical psychiatric hospital - minimal communication and I wasn't pushing it because... it's just become so routine). She told him that they may be looking at switching mood stabilizer (lithium is out), so I'm madly researching. I have a lot of questions for her, but most importantly I want to know if they checked this when he was inpatient in 2/2008, specific blood test results, and also if this could possibly be responsible for his pretty severe downturn in the last month. HA does depress CNS stuff... so I have to wonder. thank you said she mentioned trileptal, which completely flipped me out. Maybe I'm just an old dog and not adjusting well to change. Anyway, in addition to Depakote levels, CBC, and LFTs, apparently routine blood urea and blood ammonia tests would not be an unreasonable request. Edited to add: The really good news is that thank you is with it enough to have understood what he was being told, got enough info for me to at least have a clue of what was going on *and* to be able to research and get my questions in order for when psychiatrist calls. Thank goodness the kid really *is* a smart cookie, and I think he's also got the beginnings of some good self-advocacy going on, too. 'Bout time - I'm tired, LOL.