A Severe Valproate Overdose With Complete Recovery in a Newborn

Abstract

Valproate overdose, extensively described in adults and older children, has been reported in only 1 newborn: a 26-day-old female who developed a severe cerebral edema leading to a fatal outcome. Therefore, the consequences of valproate overdose are largely unknown in the neonatal period. Here, we present the clinical evolution of a 6-day-old newborn who developed hyperammonemic encephalopathy after the accidental administration of 310 mg/kg of oral valproate in a single dose. Despite the very high valproate and blood ammonia levels, he did not develop life-threatening complications and he completely recovered without sequels. His brain magnetic resonance imaging showed symmetric focal T1 prolonged signals in both globi pallidi that completely resolved over time, a neuroimaging pattern that was not previously described in valproate overdose. Our case report suggests that valproate overdose in newborns can be completely reversible even when the valproate and ammonium blood levels are very high.

Sodium valproate in association with hyponatremia and syndrome of inappropriate secretion of antidiuretic hormone: a case report

“…When hyponatremia occurs, the patient's general medical condition should be reassessed and other organic conditions that may cause hyponatremia should be excluded. Drug dose can be reduced or the drug can be changed (7,8). In our patient, there was no need for them, and when the drug was stopped supportive treatment was started, the hyponatremia disappeared.…”

Adverse Effects of Treatment with Valproic Acid during the Neonatal Period

“…Only four newborns who presented with VHE are reported in the literature including two after an overdose. [14][15][16][17] The maximum ammoniemia level is not correlated to the valproate levels. Moreover, these two values do not appear to be predictive of a more severe outcome.…”

“…In the literature, four cases were reported in newborns including two overdoses and two without overdose. [14][15][16][17] One case of overdose in a newborn resulted in death due to cerebral edema. Asymptomatic hyperammoniemia is frequent in patients treated with VPA.…”