2 cases of sodium valproate encephalopathy.

!---- sodium valproate-sodium-based hyperemiaencephalopathy (valproate-induced-inducitre," VHE), or sodium valproate encephalopathy, is a serious adverse reaction to sodium valproate, which is relatively rarethis article reports 2 cases of VHE, sum up the experience of diagnosis and treatment1Case data case 1: 51-year-old female, due to intermittent headache for 3 months in March 2018, no physical numbness, fatigue and other discomforthave no special or family historypreoperative ct and MRI examination of the left side of the cranial membrane tumor, with a maximum diameter of 5 cmopened a craniofacial tumor excision in the whole hemp and completely removed the tumorAfter, sodium valproate was given 400 mg and 0.9% sodium chloride injection 50 ml to 5 ml/h micropump input to prevent seizuresthe first day after surgery, clear mind, fluent speech, diet, no nausea and vomitingthe 3rd day after surgery, gradually appear vomiting, confusion, involuntary limbs, GCS score of 10 points, two-sided pupils and other large isospheres, diameter of 3 mm, the light reflection weakenedacute head CT did not show significant bleeding and edemablood routine, liver function, myocardial enzyme spectrum, and electrocardiogram were normal, but the blood ammonia concentration was 266 mmol/L (normal value 16 to 60 smol/L)immediately discontinued sodium valproate, after stopping the drug 2 d, the state of consciousness gradually began to improve, the diet is normalwas discharged from the hospital with a clear mind and no neurological dysfunctioncase 2: 62-year-old woman, due to left limb muscle weakness 1 month was admitted to hospital in August 2018, there is no special medical history or family historypreoperative head CT and MRI examination showed the right top lob cobweb cyst, a maximum diameter of 4 cm surgery to remove the cyst the first day after surgery, the left limb convulsion10, then gave sodium valproate 400mg plus 0.9% sodium chloride injection 50 ml to 5 ml/h micropump input, 24 h after changed to oral debakin 500 mg, 2 /d, to prevent seizures the 3rd day after surgery, clear mind, fluent speech, diet, no nausea and vomiting the 4th day after surgery began to gradually dim, silent, poor limb activity, GCS score of 11 points; acute head CT did not show significant bleeding and edema blood routine, liver function, myocardial enzyme spectrum, electrocardiogram are normal, blood ammonia concentration of 215 smol/L immediately discontinued sodium valproate and replaced treatment with ocasipin 2 d, the state of consciousness gradually began to improve, the diet is normal, the limbs are normal was discharged from the hospital with a clear mind and no neurological dysfunction 2 Discuss that sodium valproate can increase the concentration of ammonia in the blood by directly inhibiting the urea cycle or by breaking the dynamic balance of glutamine/glutine concentration in the blood; about the clinical manifestations of VHE, in the consciousness disorder, mainly manifested as drowsiness and even coma; , VHE may also show signs of damaged nervous system on one or both sides, increased frequency of seizures, dediment disorders, hallucinations, agitation and aggressive behavior serious, VHE can also cause death , eEG tests also revealed that VHE showed varying degrees of diffuse slow-wave changes CT or MRI tests generally do not have intracranial bleeding, cerebral edema, or cerebral infarction and other changes when using sodium valproate, need to closely observe the development of the disease, if there is an unexplained awareness disorder of the primary disease, and accompanied by abnormal increase in blood ammonia, then consider VHE, timely diagnosis, timely treatment note that hyperaminemia caused by sodium valproate may be asymptomatic and make up the majority , therefore, for asymptomatic patients, but also pay attention to changes in blood ammonia concentration, timely detection of potential hazards, timely correction, to avoid VHE 2 cases of gastrointestinal symptoms and consciousness disorders in this paper, after removing other common causes of consciousness disorders, finally consider VHE, timely discontinuation of sodium valproate, and give active treatment, 2 cases have a good prognosis .