Valproic Acid Overdose: Case Report and Literature Review

Authors

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

10-10-2022

Journal

The Journal of emergency medicine

DOI

10.1016/j.jemermed.2022.07.009

Keywords

L-carnitine; meropenem; overdose; toxicity; valproic acid

Abstract

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

Department

Emergency Medicine