All guns blazing: management and survival of massive valproic acid overdose - case report and literature review

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 decontam...

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Bibliographic Details
Published in:Open access emergency medicine 2018-01, Vol.10, p.31-36
Main Authors: Al Jawder, Shaikha, AlJishi, Eiman, Al-Otaibi, Shaikhah, Al-Shahrani, Mohammed S
Format: Article
Language:English
Subjects:
Ammonia
Antidepressants
Bipolar disorder
Carnitine
Case Report
Case reports
Central nervous system
Charcoal
Drug dosages
Escitalopram
FDA approval
Hemodialysis
L-carnitine
Laboratories
Levocarnitine
Liver
multiple dose activated charcoal
Poisoning
Poisons
Psychiatry
Renal replacement therapy
Valproic acid
Ventilators
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Description
Summary: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.
ISSN:1179-1500
1179-1500
DOI:10.2147/OAEM.S151095