Valproate-semisodium overdose
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Valproate-semisodium overdose Various toxicities following overdose : case report
A 29-year-old man developed agitation, coma, elevated ammonia level, elevated lactate levels, hypernatremia, metabolic acidosis and decreased blood pressure following overdose and toxicity of valproate-semisodium [duration of treatment to reaction onset and outcome not stated]. The man presented to a local emergency department after an ingested overdose of unspecified amount of an valproatesemisodium [Divalproex; DepakoteDR]. He was intubated following agitation and subsequent coma. Initial ammonia level was 150 µMol/L. Around 5 hours after the ingestion, his valproate-semisodium level was noted to be abnormal (1805 mg/L). It was found that, even after 10 hours of ingestion, the ammonia and valproate-semisodium levels continued to rise to 355 µMol/L and 2040 mg/L, respectively. Additionally, serum lactate levels were elevated to 6.7 mMol/L and he developed hypernatremia. Initial venous blood gas analysis showed metabolic acidosis with PCO2 of 43mm Hg and pH of 7.26. The man started receiving treatment with levocarnitine at the emergency department which was continued during the hospitalisation. His computed tomography imaging of the head did not show any radiographic evidence of cerebral oedema. Then, nephrology was consulted for haemodialysis (HD). The HD was initiated with a high-flux dialyser around 12.5 hours after ingestion. At the emergency department, his blood pressure decreased to 90/49mm Hg which improved with fluid resuscitation. Before HD, he had a heart rate of 84 bpm and blood pressure of 110/44mm Hg. The level of valproate-semisodium prior to discontinuation of HD was 223 mg/L. On the next day of completion of HD, his valproate-semisodium and ammonia levels improved to 84 mg/L and 75 µMol/L, respectively. Around 24 hours after the initiation of HD, he was extubated. He remained stable and was ultimately transferred for psychiatric hospitalisation. He did not experience a rebound in ammonia or valproate-semisodium levels. Sidlak AM, et al. Highest reported clearance of valproate by hemodialysis in massive overdose. American Journal of Emergency Medicine : no pagination, Jan 2020. Available from: URL: http://doi.org/10.1016/j.ajem.2020.06.073
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Reactions 22 Aug 2020 No. 1818
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