GLS and kidney failure: This swelling could compromise astrocyte energy metabolism and results in cerebral edema, and increased intracranial pressure.[7] Kidneys also contribute to the VIDH by increasing glutamate uptake and ammonia release into serum from the kidneys by glutaminase stimulation in the renal mitochondria by valproate.[8] Concomitant use of other antiepileptics like topiramate, aspirin, and cimetidine may elevate the free fraction of valproate leading to hyperammonemia.[9] Comorbid renal failure and hypoalbuminemia also contribute to VIDH.