case_images: PMC9108155_01
case_images: PMC9108155_02
case_images: PMC9108155_03
case_images: PMC9108155_04
case_images: PMC9108155_05
case_images: PMC9108155_06
case_images: PMC9108155_07
case_images: Management summary: therapeutic strategy, clinical course and diagnostic tests. EEG, electroencephalogram; ER, extended release; NA, not administered; N, normal values  ; CT, computed tomography (brain) scan; T, abnormal; ?, normal, within normal limits;  , elevated value, within normal limits;   , elevated value, above normal or supratherapeutic;  , decreased value, within normal limits;   , decreased value, below normal or subtherapeutic;  : discontinued;   Normal values: serum lithium level: N = (0.84-1.2) mg/l; serum valproate level: N = (41-100) mEg/l; serum ammonia level: N = (16-60) mumol/l.
case_images: fpsyt-13-875636-g0001.jpg
case_images: PMC9108155_07_fpsyt-13-875636-g0001.jpg
case_images: F1
case_images: The rechallenge of the combination long after the first episode then enabled a more objective examination of another increase in the serum valproate level, with more moderate hyperammonemia (without encephalopathy or associated clinical signs), concomitant with the re-initiation of lithium, despite a progressive decrease in the doses of valproate semisodium administered (Figure 1).