The authors report the case of a patient who developed hyperammonemia and coma during therapy with valproic acid for affective disorder. Onset of the coma was gradual and initially interpreted as a therapeutic reduction in the patient's anxiety. In a psychiatric setting, treatment of hyperammonemia may be delayed if a patient's increasing lethargy is interpreted as a therapeutic response. Staff may need to be educated about the potential for hyperammonemia, and patients whose tolerance for valproic acid is unknown may need to be monitored for liver function and blood levels of urea and ammonia.
CD + counts were studied. Two hundred (40%) of the patients had normal abdominal ultrasound, while 60% (300) had various abnormalities. The common abnormalities included increased liver parenchymal echogenicity in 25.0%, hepatomegaly in 23.4%, splenomegaly in 6.6%, increased splenic echogenicity in 6.2% and thickened gallbladder wall in 12.6%, elevated renal parenchymal echogenicity in 6.4%, enlarged kidneys in 2.6%, lymphadenopathy in 6.0%, and ascites in 2.4%. Pelvic abscess was the least pathology in 0.2%.Most of the findings did not correlate with the patients' 4 CD + count except for lymphadenopathy and ascites. Although abdominal ultrasound examination is invaluable in the management of these patients, however, it has not shown to be useful in predicting the patients' immune status.
Hepatobiliary diseases occur commonly in patients with Human immunodeficiency virus (HIV) infection and are now the commonest cause of death in HIV positive patients on antiretroviral therapy (ART) in western countries. The hepatobiliary manifestations of AIDS are related to the levels of CD 4 + count as well as liver enzymes. Abdominal ultrasound examination is easy to perform, non-invasive, inexpensive, readily available and provides valuable information about hepatobiliary findings in AIDS. The study was to evaluate hepatobiliary sonographic findings in HIV/AIDS adult patients and correlate with their CD 4 + count and abnormal liver enzymes (ALP, ALT and AST) in Jos, Plateau State, Nigeria. A cross-sectional study of hepatobiliary ultrasound findings of 410 adult patients with HIV/AIDS was carried out over a period of six months. Two hundred and sixteen (52.7%) of the patients had normal hepatobiliary ultrasound findings while 194 (47.3%) patients had various abnormalities. The common abnormalities seen include enlarged gallbladder in 33.5%, increased liver parenchymal echogenicity in 26.3%, hepatomegaly in 23.7%, and thickened gallbladder wall in 7.8% patients. Other findings included gallbladder sludge and gall stone in 6.6 and 2.1% respectively. These findings correlated significantly with the patients' CD 4 + count and liver enzymes (ALT, AST and ALP) with p value < 0.05 in both. Ultrasonography as a baseline imaging modality in HIV/AIDS patients, together with CD 4 + count and liver enzymes are useful in the assessment of the disease state, monitoring of therapy and management of these patients.
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