Valproic acid toxicity

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Background

  • Peak concentration occurs within 4hr (12-18hr for controlled release forms)

Clinical Features

  • CNS depression
  • Hypotension
  • Respiratory depression

Diagnosis

  • Level
    • Does not correlate well w/ toxicity
    • Adverse effects increase w/ level >150
  • Chemistry
    • Hypocalcemia, hypernatremia, hypophosphatemia, AG metabolic acidosis
  • LFT
    • Elevated transaminases, hyperammonemia

Treatment

  • GI detox
    • Activated charcoal PO x1 or multidose (for delayed-release preparations)
  • l-carnitine
    • Increases valproate metabolism
    • Recommended for pts with:
      • Lethargy, coma, hyperammonemia, hepatic dysfunction
    • Give 50mg/kg/day IV in 3divided doses
  • Naloxone
    • May be effective in reversing CNS depression
  • Dialysis
    • Effective

Disposition

  • Consider d/c for pt with declining levels and pt is asymptomatic

Source

Tintinalli

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