Hyperammonemia in a 20-Year-Old Woman

1. What is (are) this patient’s most striking clinical and laboratory findings? 2. What are the causes of hyperammonemia? 3. What is this patient’s most likely diagnosis? 4. What is the mechanism of ammonia production? 5. What is the mechanism of valproic acid-induced hyperammonemia? 6. What other drugs can induce hyperammonemia? 7. What are the effects of chronic hyperammonemia? 8. Is the magnitude of the VPA-induced hyperammonemia in our patient “clinically” significant? 9. What is the usual treatment for hyperammonemia? 10. What are the appropriate specimen collection and handling procedures for ammonia testing?