Abstract：
A 63-year-old man developed reduced consciousness and dysphagia progressively. Examination and parameters were normal, except for a Glasgow Coma Scale score of seven, and his grading on the swallow water test increased from grade 1 to grade 5. Brain imaging and blood tests were unexplainable except by high plasma ammonia. His past medical history included cerebral infarction, hypertension and epilepsy induced by cerebral hyperperfusion syndrome. He was rceiving antiepileptic treatment of continuously intravenously pumped sodium valproate of 64 mg/h for 4 days, which overlapped for 12 hours with taking 500 mg sustained release tablets. Sodium valproate was stopped; testing demonstrated normal plasma concentrations of sodium valproate and elevated concentrations of ammonia. Ornithine aspartate was administrated. The patient\'s level of responsiveness and ammonia levels gradually improved. The patient was also being treated with ceftriaxone sodium for a hypostatic pneumonia and with desmopressin for diabetes insipidus. There is an association between sodium valproate and hyperammonaemia and encephalopathy. Immediate recognition of the serious but uncommon adverse effects is essential. To our knowledge this is the first report of ornithine aspartate being used in this disorder.
摘要：
一名63岁的男子逐渐出现意识下降和吞咽困难。检查和参数正常，除了格拉斯哥昏迷评分7分，他在燕水测试中的等级从1级提高到5级。除了高血浆氨，脑成像和血液检查无法解释。他的既往病史包括脑梗塞，脑高灌注综合征引起的高血压和癫痫。他正在接受持续静脉泵入64mg/h丙戊酸钠的抗癫痫治疗4天，与服用500mg缓释片重叠12小时。停止丙戊酸钠;测试显示丙戊酸钠的正常血浆浓度和升高的氨浓度。给予天门冬氨酸鸟氨酸。患者的反应性水平和氨水平逐渐改善。该患者还接受头孢曲松钠治疗坠积性肺炎，去氨加压素治疗尿崩症。丙戊酸钠与高氨血症和脑病之间存在关联。必须立即认识到严重但不常见的不良反应。据我们所知，这是天冬氨酸鸟氨酸用于这种疾病的第一份报告。
