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

Authors Al Jawder S, AlJishi E, Al-Otaibi S, Al-Shahrani MS

Received 7 September 2017

Accepted for publication 17 November 2017

Published 25 January 2018 Volume 2018:10 Pages 31—36


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 2

Editor who approved publication: Dr Hans-Christoph Pape

Shaikha Al Jawder,1 Eiman AlJishi,2 Shaikhah Al-Otaibi,2 Mohammed S Al-Shahrani3

1King Hamad University Hospital, Busaiteen, Bahrain; 2Emergency Medicine Department, 3Emergency and Critical Care Department, King Fahad Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia

Abstract: 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.

Keywords: valproic acid, multiple dose activated charcoal, l-carnitine, hemodialysis

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