Chronic valproic acid intoxication: reversal by naloxone

A 76-year-old woman being treated with sodium valproate for bipolar depression presented with a 4 day history of acute confusion and tremulousness. She had apnoeic episodes, reduced conscious level and generalised myoclonic movements. Her plasma valproate concentration was 848 µmol/l (normal 300–600...

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Published inEmergency medicine journal : EMJ Vol. 24; no. 9; pp. 677 - 678
Main Author Thanacoody, H K R
Format Journal Article
LanguageEnglish
Published England BMJ Publishing Group Ltd and the British Association for Accident & Emergency Medicine 01.09.2007
BMJ Publishing Group LTD
BMJ Group
Subjects
Acids
Aged
Antimanic Agents - poisoning
Bipolar Disorder - drug therapy
Blood pressure
Coma
Emergency Casebook
Female
Hemodialysis
Humans
Intoxication
Naloxone - therapeutic use
Narcotic Antagonists - therapeutic use
Narcotics
Plasma
Poisoning - drug therapy
Toxicity
Valproic Acid - poisoning
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Summary:A 76-year-old woman being treated with sodium valproate for bipolar depression presented with a 4 day history of acute confusion and tremulousness. She had apnoeic episodes, reduced conscious level and generalised myoclonic movements. Her plasma valproate concentration was 848 µmol/l (normal 300–600 µmol/l). Administration of naloxone 0.8 mg led to rapid clinical improvement. Naloxone may be useful in reversing the features of chronic valproate toxicity.
Bibliography:Correspondence to:
 Dr H K R Thanacoody
 Scottish Poisons Information Bureau, Royal Infirmary Edinburgh, 51 Little France Crescent, Edinburgh, UK; ruben.thanacoody@luht.scot.nhs.uk
PMID:17711961
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ark:/67375/NVC-S2W3VRCV-2
href:emermed-24-677.pdf
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ISSN:1472-0205
1472-0213
DOI:10.1136/emj.2007.049791