Patient/caregiver was educated on precautions to be exercised while taking Divalproex as follows:

• 1. Divalproex sodium use can result in acute pancreatitis, with individuals complaining acute upper abdominal pain and tenderness that can aggravate after eating, nausea and vomiting, abdominal fullness and distension, and bloating. Notify your physician regarding any such findings for a possible change in the plan of care. Also, report to your physician regarding any history of pancreatitis.
  2. Ammonia is a toxic product produced in the body during normal protein metabolism. Conversion of toxic ammonia to less toxic urea takes place significantly in the liver and to a lesser extent in the kidneys, by action of enzymes of the urea cycle. So, normal function of liver and kidney is very important for this uncompromised detoxification of ammonia to urea. In individuals with compromised liver and kidney function, this conversion can suffer, thus resulting in accumulation of ammonia in the body. Divalproex use can result in hepatic damage and compromised liver function, thus contributing to reduced detoxification of ammonia to urea and elevated ammonia levels in the body. Significantly elevated ammonia levels can be toxic to the brain and result in impaired memory, shortened attention span, severe confusion, disturbed sleep, restlessness, seizures, and in severe cases can result in coma and death. So, divalproex is used with extreme caution in individuals with history of urea cycle disorder, compromised liver and renal function.