Answer and interpretation This is probably valproic acid induced hyperammonia encephalopathy (VHE) VHE has been reported secondary to acute VPA overdose and in chronic normal therapeutic dosing, presenting as an acute and profound decreased level of consciousness, with or without increased seizure activity this is usually in association with an increased serum ammonia level (Mock and Schwetschenau, 2008) Patients at higher risk for VHE include those with liver impairment, on multiple anticonvulsants, or have other causes of increased ammonia production
Serious adverse effects require immediate medical attention
However, if this occurred at an industrial scale, it could draw the ire of FDA or Lilly as an end-around to the rules prohibiting the compounding of copies of commercially available drugs
Your healthcare team may submit a report to the MHRA Yellow Card Scheme, which helps regulators track real-world pregnancy outcomes after GLP-1 exposure You dont need to taper the dose
This population-level increase suggests widespread adoption directly contributed to surging blinding events