par Khattar, Lina ;Brasseur, Alexandre ;Antonucci, E;Vincent, Jean Louis ;Taccone, Fabio
Référence European Society of Intensive Care Medecine Annual Congress(XXVI: 5-9 October 2013: Paris), 26th ESICM Annual Congress
Publication Publié, 2013-10
Abstract de conférence
Résumé : INTRODUCTION. Elevated ammonium levels (EAL) are one of the side effects of valproic acid (VPA) treatment. This complication has been described during long-term VPA treatment, but less in critically ill patients.OBJECTIVES. The aim of this study was to evaluate the incidence and the factors associated with EAL in those patients.METHODS. A retrospective study in a mixed 35-bed ICU care of a tertiary university hospital was conducted over a 4-year period (2007-2010). Inclusion criteria were; a) VPA therapy for more than 72 hours; b) age > 18 years; c) at least one measurement of ammonium levels during the ICU stay; d) Child C liver cirrhosis. EAL was defined as ammonium levels above 50 mcg/dL. Demographic data, comorbidities, reason for VPA treatment, biological data, concomitant therapies, presence of infection and ICU mortality were collected.RESULTS. A total of 168 patients met the inclusion criteria (median age 64 years, 95 male gender). Most of them (137/168) were admitted for neurological reasons. Overall ICU mortality was 23%. Median ammonium levels were 88 [55-121] mcg/dL. EAL was found in 121 (72%) patients; of those, 38 (31%) had ammonium levels between 100-150 mcg/dL, 11 (9%) between 150-200 mcg/dL and 13 (11%) above 250 mcg/dL. Median time from start of VPA therapy to EAL was 4 [3-5] days. Median maximum VPA level during therapy was 72 [51-88] and was significantly higher in EAL patients than in the others (76 [58-92] mcg/mL vs. 56 [39-81] mcg/mL, p< 0.01). EAL were more frequently observed in patients with sepsis (p< 0.01) and in those treated with mechanical ventilation (p< 0.01), vasopressors (p=0.05) and at least one other antiepileptic drug (p=0.02); these patients tended to have a higher ICU mortality (28% vs. 13%, p = 0.06).CONCLUSIONS. Ammonium levels are often elevated during treatment with valproic acid in ICU patients, especially in those with the greatest severity. This alteration may contribute to their alteration in brain function.