Valproic Acid Overdose: Case Report and Literature Review

Patel, Jigar; Berezowski, Ivan; Mazer‐Amirshahi, Maryann; Frasure, Sarah E.; Tran, Quincy; Pourmand, Ali

doi:10.1016/j.jemermed.2022.07.009

Cited by 4 publications

(4 citation statements)

References 27 publications

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“…Valproic acid may also induce a latent chronic pancreatitis, which is detected if it results in an acute-onset symptomatic pancreatitis episode [ 5 , 6 ]. Finally, an acute pancreatic damage, mostly associated with signs of septic shock, such as low blood pressure, high heart rate, and increased body temperature, in addition to respiratory depression, nausea, vomiting, diarrhea, miosis, agitation, trembling, and myoclonus, has been noted in the context of an acute valproic acid poisoning [ 90 ].…”

Section: Discussionmentioning

confidence: 99%

Valproic Acid-Associated Acute Pancreatitis: Systematic Literature Review

Bischof,

Stadelmann,

Janett

et al. 2023

JCM

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Long-term medication with valproic acid has been associated with acute pancreatitis. The purpose of this report is to gain insight into the features of this pancreatitis. A preregistered literature search (CRD42023438294) was performed on the National Library of Medicine, Excerpta Medica, Web of Science, and Google Scholar. Patients with alcohol abuse disorder, gallstone disease, hypertriglyceridemia or hypercalcemia, patients with acute valproic acid intoxication, and patients with a pre-existing pancreatitis were excluded. For the final analysis, we retained 73 reports published between 1979 and 2023, which described 125 subjects (83 children and 42 adults predominantly affected by an epilepsy) with an acute pancreatitis related to valproic acid. The diagnosis was made 11 (3.0–24) months (median and interquartile range) after starting valproic acid. One hundred and five cases (84%) recovered and twenty (16%) died. Sex, age, dosage or circulating level of valproic acid, latency time, prevalence of intellectual disability, and antiepileptic co-medication were similar in cases with and without a lethal outcome. Nineteen subjects were rechallenged with valproic acid after recovery: sixteen (84%) cases developed a further episode of pancreatitis. In conclusion, pancreatitis associated with valproic acid presents at any time during treatment and has a high fatality rate.

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Section: Discussionmentioning

confidence: 99%

Valproic Acid-Associated Acute Pancreatitis: Systematic Literature Review

Bischof,

Stadelmann,

Janett

et al. 2023

JCM

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“…Sodium valproate (VPA) is a commonly prescribed antiepileptic drug with a narrow therapeutic range of 50-100 μ g/ml [ 1 ]. Transgressing this range leads to a reduction in protein binding with a resultant increase in free valproic acid [ 2 ], as well as an increased half-life of >30 hours [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Simultaneous, Dual Continuous Venovenous Haemodiafiltration as Salvage Therapy for Severe Sodium Valproate Intoxication

Hussan,

Hasan,

El-Hayani

et al. 2024

Case Reports in Critical Care

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Sodium valproate overdose leads to CNS depression, cerebral oedema, and severe metabolic acidosis in cases of severe toxicity. Extracorporeal removal, specifically through intermittent haemodialysis, is recommended, though not always tolerated by or accessible to haemodynamically unstable patients in intensive care units. We present a case of a male in his mid-twenties presenting following a massive, intentional overdose of 13 g of sodium valproate over 7 hours, with an initial valproate blood concentration of 975 μg/ml (normal 50-100 μg/ml). He was hypoxic and severely acidotic on arrival and was given fluids and L-carnitine according to TOXBASE guidelines. This resulted in only marginal improvement to his acidosis. Once transferred to our intensive care unit, the patient was started on inotropic support followed by continuous venovenous hemofiltration (CVVHDF) at the maximum effluent rate of 60 ml/kg/hr. Due to his persisting metabolic acidosis and worsening hyperlacataemia, dual CVVHDF was started by adding another filter in series after 26 hours, increasing the maximum effluent rate to 96 ml/kg/hr. The patient remained on dual CVVHDF for 31 hours, during which his acidosis and lactate showed considerable improvement, and he was subsequently stepped down to single-filter CVVHDF for a further 20 hours until complete resolution of his acidosis. This case report recognises dual CVVHDF as a viable salvage therapy for severe sodium valproate overdose by facilitating the achievement of a higher effluent flow rate compared to what can be accomplished with single-filter CVVHDF.

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“…The leading life‐threatening toxicity and complications of VPA poisoning are central nervous system toxicity, hyperammonemia encephalopathy, acute liver, and renal failure 8 . Rescue of acute VPA poisoning mainly includes in vitro elimination such as hemoperfusion (HP), hemodialysis (HD), hemofiltration (HF), 9 and drug rescue such as L‐carnitine, meropenem 10,11 . However, there are some disputes over the use of drugs.…”

Section: Introductionmentioning

confidence: 99%

“… 8 Rescue of acute VPA poisoning mainly includes in vitro elimination such as hemoperfusion (HP), hemodialysis (HD), hemofiltration (HF), 9 and drug rescue such as L‐carnitine, meropenem. 10 , 11 However, there are some disputes over the use of drugs. We reported three cases of HP, HD, and continuous renal replacement therapy (CRRT) based on blood concentration monitoring to eliminate VPA to rescue acute VPA poisoning, and provide a reference for emergency treatment of acute valproic.…”

Section: Introductionmentioning

confidence: 99%

Rescue strategies for valproic acid overdose poisoning: Case series and literature review

Liu,

Xiao,

et al. 2023

Clinical Case Reports

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Key Clinical MessageValproic acid (VPA) is a wide‐ranging anti‐epileptic medication that primarily affects bipolar disorder, mania, and migraine. The leading causes of mortality associated with acute poisoning from VPA are nervous system toxicity, drug‐induced shock due to encephalopathy from hyperammonemia, as well as acute liver and kidney failure, and respiratory depression that contribute to hemodynamic instability. Treatment of acute VPA poisoning primarily involves in vitro elimination methods, including hemoperfusion (HP), hemodialysis, and hemofiltration, as well as drug remedies such as L‐carnitine and meropenem. Nonetheless, there are conflicting opinions regarding drug usage. This article details the three cases of acute poisoning from VPA. The fundamental approach to treatment employs HP assisted by blood concentration monitoring to alleviate shock and stabilize hemodynamics. This investigation presents guidance for the treatment and management of acute poisoning with VPA in clinical settings.

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Valproic Acid Overdose: Case Report and Literature Review

Cited by 4 publications

References 27 publications

Valproic Acid-Associated Acute Pancreatitis: Systematic Literature Review

Valproic Acid-Associated Acute Pancreatitis: Systematic Literature Review

Simultaneous, Dual Continuous Venovenous Haemodiafiltration as Salvage Therapy for Severe Sodium Valproate Intoxication

Rescue strategies for valproic acid overdose poisoning: Case series and literature review

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