What are the effects of taking 300 pills of sodium valproate? - case report

Abstract

INTRODUCTION: Sodium valproate is one of the most important antiepileptic drugs. It can be effective as a preventive treatment for migraine, it has also found use in the maintenance treatment of bipolar disorder and acute mania,it is sometimes used in the treatment of chronic neuropathic pain and fibromyalgia, in the treatment of schizophrenia borderline personality disorder and acquired brain injury, this drug is used off-label. Its overdose can be fatal.
 MATERIALS AND METHOD: Patient information was collected from hospital records available in the clinical toxicology department. In addition, we conducted a literature review on sodium valproate treatment, its toxicity, side effects and pharmacokinetics using PubMed.
 CASE REPORT: A 57-year-old patient with a history of depressive disorders was admitted to the Clinical Department of Toxicology and Cardiology in Lublin for intentional intoxication with the drug Absenor (sodium valproate). The patient had taken 3 packages of Absenor 500 mg (300 tablets in total) for suicidal purposes. The determined concentration of valproic acid was 841 µg/ml, and the patient's condition was very severe. Despite the treatment administered-multiple attempts at gastric lavage, administration of activated charcoal, performance of hemodialysis procedures, administration of infusion of catecholamines, the patient died on the fifth day of hospitalization.
 CONCLUSION: An overdose of sodium valproate can be fatal. Keep this in mind when ordering this drug for patients with a positive history of suicide attempts.

Carbapenems as Antidotes for the Management of Acute Valproic Acid Poisoning

“…If the concentration of VPA is within the therapeutic range, there appears to be a small risk of this drug’s toxicity. However, if VPA levels exceed this range, acute poisoning may happen [ 5 ].…”

“…The symptoms of poisoning depend on the severity of intoxication, which is, for clinical purposes, usually categorized using the Poisons Severity Score into (0) an absence of poisoning, (1) minor poisoning, (2) moderate poisoning, (3) severe or life-threatening poisoning and (4) fatal poisoning [ 26 ]. Commonly, symptoms of VPA poisoning include, as reported by Pozarowska et al, confusion, sedation, coma, muscle weakness, weakened reflexes or areflexia, miosis, respiratory distress, metabolic acidosis, hypoglycemia, cardiovascular disorders, hypotension and circulatory failure or shock [ 5 ]. The symptoms that were reported in our study are in accordance with the ones that were mentioned above and they were predominantly an altered mental status (from somnolence to coma), miosis, respiratory distress and hypotension.…”

“…Sometimes, it can be used to treat chronic neuropathic pain and fibromyalgia [ 4 ]. The off-label use is related to the treatment of schizophrenia, borderline personality disorder and acquired brain injury [ 4 , 5 ].…”