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Depakote and hyperammonemia
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<blockquote data-quote="slsh" data-source="post: 143168" data-attributes="member: 8"><p>LOL, Kate - sorry, had to laugh. Lethargy and confusion are thank you's baseline. Only things I know for sure are that he's been sliding deeper into depression for ... gosh, I don't know, several months? So, he's been sleeping more, which is really his standard MO for anytime he's depressed *or* anytime he's avoiding stuff (pretty much 24/7/365). Confusion... really hard to get a feel for that because his thought processes are pretty goofy to start with. I think more delusional than usual would be a better description, which could also be part of the escalating depression. But absolutely, one of my questions for the psychiatrist is going to be could the HA have played a part in this admission.</p><p></p><p>klmno - lithium is out because it fried his thyroid years ago. He was on it about 8 months and developed a goiter that was *humongous*. He just was able to come off Synthroid last year finally. Endocrinologist was at one point talking about a partial thyroidectomy it was so big. Because of his age and because we're facing a very real possibility of him being in a situation in about a year or so where medication noncompliance is a probability, I'm not willing to put him on a medication that could cause serious physical problems (the thyroid) if/when he decides to quit all medications altogether. I'm not sure why the ammonia level is out of whack now - it could be just one of those things. I also have to wonder if he's been cheeking medications and OD'd, though I would think there would have been other signs. I don't know - he's a mess and I wouldn't rule anything out as possible. Since they caught it this admission, I would think they checked it in 2/2008 as well, but I will be quizzing psychiatrist. I always ask about CBC, LFTs, Depakote levels, and drug screens, but I've never asked specifically about ammonia or urea. </p><p></p><p>I found a couple of case studies of hyperammonemia but of course they were worst case scenarios involving coma (but successful reversal and full recovery). The one was a woman on Depakote for affective disorder and part of the conclusion of the case study was that early symptoms of HA can mimic what you would see as a person on the manic side of things gets therapeutic on Depakote. "This case illustrates the danger of interpreting changes in mood and behavior that are due to hyperammonemia as a therapeutic response to valproic acid in treatment of a patient with hypomanic symptoms." Guess it's a rare case of where the hoofbeats actually *could* be a zebra.</p></blockquote><p></p>
[QUOTE="slsh, post: 143168, member: 8"] LOL, Kate - sorry, had to laugh. Lethargy and confusion are thank you's baseline. Only things I know for sure are that he's been sliding deeper into depression for ... gosh, I don't know, several months? So, he's been sleeping more, which is really his standard MO for anytime he's depressed *or* anytime he's avoiding stuff (pretty much 24/7/365). Confusion... really hard to get a feel for that because his thought processes are pretty goofy to start with. I think more delusional than usual would be a better description, which could also be part of the escalating depression. But absolutely, one of my questions for the psychiatrist is going to be could the HA have played a part in this admission. klmno - lithium is out because it fried his thyroid years ago. He was on it about 8 months and developed a goiter that was *humongous*. He just was able to come off Synthroid last year finally. Endocrinologist was at one point talking about a partial thyroidectomy it was so big. Because of his age and because we're facing a very real possibility of him being in a situation in about a year or so where medication noncompliance is a probability, I'm not willing to put him on a medication that could cause serious physical problems (the thyroid) if/when he decides to quit all medications altogether. I'm not sure why the ammonia level is out of whack now - it could be just one of those things. I also have to wonder if he's been cheeking medications and OD'd, though I would think there would have been other signs. I don't know - he's a mess and I wouldn't rule anything out as possible. Since they caught it this admission, I would think they checked it in 2/2008 as well, but I will be quizzing psychiatrist. I always ask about CBC, LFTs, Depakote levels, and drug screens, but I've never asked specifically about ammonia or urea. I found a couple of case studies of hyperammonemia but of course they were worst case scenarios involving coma (but successful reversal and full recovery). The one was a woman on Depakote for affective disorder and part of the conclusion of the case study was that early symptoms of HA can mimic what you would see as a person on the manic side of things gets therapeutic on Depakote. "This case illustrates the danger of interpreting changes in mood and behavior that are due to hyperammonemia as a therapeutic response to valproic acid in treatment of a patient with hypomanic symptoms." Guess it's a rare case of where the hoofbeats actually *could* be a zebra. [/QUOTE]
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