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Valproic acid overdose: case report and literature review.
Jigar Patel , Department of Emergency Medicine, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia. Ivan Berezowski , Department of Emergency Medicine, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia. Maryann Mazer-Amirshahi , Department of Emergency Medicine, MedStar Washington Hospital Center and Georgetown University School of Medicine, Washington, District of Columbia. Sarah E. Frasure , Department of Emergency Medicine, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia. Quincy K. Tran , Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland; Program in Trauma, The R. Adam Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland. Ali Pourmand , Department of Emergency Medicine, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia.
Document Type
Journal Article
Publication Date
The Journal of emergency medicine
10.1016/j.jemermed.2022.07.009
L-carnitine; meropenem; overdose; toxicity; valproic acid
BACKGROUND: Valproic acid (VPA) is a common antiepileptic drug that is also used routinely for various psychiatric disorders. VPA toxicity typically manifests as central nervous system depression, while hyperammonemic encephalopathy and hepatotoxicity are potentially life-threatening complications. CASE REPORT: We describe the case of a 56-year-old man who presented to the emergency department after an intentional VPA overdose, was found to have hyperammonemia, and was treated with L-carnitine exclusively. He was subsequently admitted to the hospital for monitoring and serial laboratory testing. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Although VPA toxicity has conventionally been managed by gastric decontamination, L-carnitine, and, in severe and refractory cases, extracorporeal removal, recent literature supports the use of carbapenem antibiotics, particularly meropenem. Thus, we report the details of current treatment modalities for VPA toxicity by reviewing current literature.
APA Citation
Patel, Jigar; Berezowski, Ivan; Mazer-Amirshahi, Maryann; Frasure, Sarah E.; Tran, Quincy K.; and Pourmand, Ali, "Valproic Acid Overdose: Case Report and Literature Review" (2022). GW Authored Works. Paper 1796. https://hsrc.himmelfarb.gwu.edu/gwhpubs/1796
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All guns blazing: management and survival of massive valproic acid overdose - case report and literature review
Affiliations.
- 1 King Hamad University Hospital, Busaiteen, Bahrain.
- 2 Emergency Medicine Department.
- 3 Emergency and Critical Care Department, King Fahad Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
- PMID: 29416381
- PMCID: PMC5790066
- DOI: 10.2147/OAEM.S151095
A 51-year-old woman, who intentionally ingested a massive dose of ~60 g of valproic acid which she was using as a mood stabilizer for bipolar affective disorder, presented within 30 minutes of ingestion to the emergency department. The patient was asymptomatic and was immediately started on decontamination therapy with activated charcoal (AC). Drug serum levels, liver functions, and ammonia levels were tested and followed up during treatment. Due to the massive ingestion and continuous rise in serum drug levels, the patient received regular multiple doses of AC, as well as l-carnitine for liver protection. The patient was started on extracorporeal therapy in the form of renal replacement therapy in the intensive care unit (ICU), followed by intermittent hemodialysis. Drug serum levels dropped significantly. Ammonia levels showed improvement with treatment. The patient was discharged from the ICU after 14 days of treatment. She was stable and in good condition with no residual hepatic or central nervous system (CNS) manifestations.
Keywords: hemodialysis; l-carnitine; multiple dose activated charcoal; valproic acid.
Publication types
- Case Reports
IMAGES
VIDEO
COMMENTS
Substances. Valproic Acid. Anticonvulsants. Carnitine. We describe the case of a 56-year-old man who presented to the emergency department after an intentional VPA overdose, was found to have hyperammonemia, and was treated with L-carnitine exclusively. He was subsequently admitted to the hospital for monitoring and serial laboratory testing.
Introduction. Valproic acid (VPA), a branched-chain carboxylic acid, is an antiepileptic drug used to treat various seizure types (1).It is also used routinely to treat acute mania, as maintenance therapy for mood disorders, and as prophylaxis for migraine headaches (2).Due to its widespread use and narrow therapeutic range of 50-100 μg/mL, acute and chronic toxicity from VPA overdose and ...
1 INTRODUCTION. Valproic acid (VPA) is a branched short-chain fatty acid derived from valeric acid, a low molecular weight carboxylic acid. 1 VPA is a broad-spectrum anti-epileptic drug. It is the first-line drug for various types of epilepsy and is the first choice for mandatory seizures. 2, 3 VPA has also been effective in bipolar disorder, mania, anxiety, and migraine. 4-6 Because of its ...
Request PDF | Valproic Acid Overdose: Case Report and Literature Review | Background: Valproic acid (VPA) is a common antiepileptic drug that is also used routinely for various psychiatric disorders.
DOI: 10.1016/j.jemermed.2022.07.009 Corpus ID: 252841172; Valproic Acid Overdose: Case Report and Literature Review. @article{Patel2022ValproicAO, title={Valproic Acid Overdose: Case Report and Literature Review.}, author={Jigar Patel and Ivan Berezowski and Maryann Mazer-Amirshahi and Sarah E. Frasure and Quincy K. Tran and Ali Pourmand}, journal={The Journal of emergency medicine}, year ...
Clinical Case Reports aims to improve global health outcomes by sharing clinical knowledge through the use of medical case reports, clinical images & procedural videos. Key Clinical Message Valproic acid (VPA) is a wide-ranging anti-epileptic medication that primarily affects bipolar disorder, mania, and migraine. ... Case series and literature ...
A case is presented of an adolescent with ischemic ECG changes after an acute overdose of VPA with review of the current medical literature. Case Report. A 16-year-old female presented to the emergency department with an intentional overdose of 20 VPA (250 mg) pills. She denied fever, chest pains, dyspnea, or vomiting.
Case Report. We describe the case of a 56-year-old man who presented to the emergency department after an intentional VPA overdose, was found to have hyperammonemia, and was treated with L-carnitine exclusively. He was subsequently admitted to the hospital for monitoring and serial laboratory testing.
of acute valproic. Received: 7 July 2023 | Revised: 25 November 2023 | Accepted: 14 December 2023 DOI: 10.1002/ccr3.8367 CASE SERIES Rescue strategies for valproic acid overdose poisoning: Case series and literature review Renzhu Liu1,2 | Lu Xiao3 | Yixiang Hu1,2 | Qingzi Yan1,2 | Xiang Liu1,2
Valproic acid (VPA), a branched-chain carboxylic acid, is an antiepileptic drug used to treat various seizure types (1). It is also used routinely to treat acute mania, as maintenance therapy for mood disorders, and as prophylaxis for migraine headaches (2). Due to its widespread use and narrow therapeutic range of 50-100 μg/mL, acute and ...
BACKGROUND: Valproic acid (VPA) is a common antiepileptic drug that is also used routinely for various psychiatric disorders. VPA toxicity typically manifests as central nervous system depression, while hyperammonemic encephalopathy and hepatotoxicity are potentially life-threatening complications. CASE REPORT: We describe the case of a 56-year-old man who presented to the emergency department ...
Case report: We describe the case of a 56-year-old man who presented to the emergency department after an intentional VPA overdose, was found to have hyperammonemia, and was treated with L ...
Table 2 Review of published case reports about valproic acid toxicity Download CSV Display Table In our case, we used the three main interventions (multidose AC, l-carnitine, and HD) that have been reported in the literature.
A 51-year-old woman, who intentionally ingested a massive dose of ~60 g of valproic acid which she was using as a mood stabilizer for bipolar affective disorder, presented within 30 minutes of ingestion to the emergency department. ... management and survival of massive valproic acid overdose - case report and literature review Open Access ...
Valproic acid (VPA) is a common antiepileptic drug that is also used routinely for various psychiatric disorders. VPA toxicity typically manifests as central nervous system depression, while hyperammonemic encephalopathy and hepatotoxicity are potentially life-threatening complications.
Because of first-order kinetics, half-life can range from 5 to 20 hours. [ 1] The 3 major metabolites of VPA are 2-EN-VPA, 4-EN-VPA, and propionic acid derivatives. 2-EN-VPA may mediate cerebral ...
The cardiovascular examination revealed a regular rhythm with notable tachycardia without murmurs. The lungs were clear. The abdomen had positive bowel sounds, was soft, nontender, with no ...