Rising Trends of Serum Ammonia in Psychiatric Patients: A Clinical Observational Study

Background: Elevated serum ammonia (hyperammonemia) is a frequently overlooked complication in psychiatric patients. While commonly associated with liver dysfunction, medications such as valproic acid (VPA) can significantly contribute to hyperammonemia, resulting in neuropsychiatric disturbances and treatment resistance. Objective: This study assesses the prevalence, potential causes, and clinical outcomes of elevated serum ammonia levels in psychiatric inpatients. Methods: We conducted a retrospective observational study at Nirvan Institute of Mental Health and Neurosciences, Lucknow, evaluating psychiatric inpatients with documented serum ammonia levels. Collected data encompassed demographics, psychiatric diagnoses, medication history (emphasizing VPA), clinical presentation, laboratory values, and treatment outcomes. Descriptive statistics, including means, standard deviations, and percentiles, were employed for analysis. Results: Among 12 psychiatric inpatients assessed, the mean serum ammonia level was 229.88 µmol/L (range: 2.34–317.70 µmol/L), substantially exceeding normal thresholds (15–45 µmol/L). Elevated ammonia levels were predominantly observed in patients receiving VPA therapy or those with liver dysfunction. Clinical symptoms associated with hyperammonemia included confusion, cognitive impairment, hallucinations, withdrawal behaviors, and acute delirium. Conclusion: Regular monitoring of serum ammonia in psychiatric patients, particularly those on VPA or presenting with altered mental states, is essential for early identification and management, potentially reducing morbidity and healthcare burdens.