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

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...

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Main Authors: Al Jawder S, AlJishi E, Al-Otaibi S, Al-Shahrani MS
Format: Article
Language:English
Published: Dove Medical Press 2018-01-01
Series:Open Access Emergency Medicine
Subjects:
Online Access:https://www.dovepress.com/all-guns-blazing-management-and-survival-of-massive-valproic-acid-over-peer-reviewed-article-OAEM
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spelling doaj-43f018bb89754217815a4b4729435a082020-11-25T02:35:52ZengDove Medical PressOpen Access Emergency Medicine1179-15002018-01-01Volume 10313636546All guns blazing: management and survival of massive valproic acid overdose – case report and literature reviewAl Jawder SAlJishi EAl-Otaibi SAl-Shahrani MSShaikha 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, hemodialysishttps://www.dovepress.com/all-guns-blazing-management-and-survival-of-massive-valproic-acid-over-peer-reviewed-article-OAEMValproic acidmultiple dose activated charcoalL-carnitinehemodialysis
collection DOAJ
language English
format Article
sources DOAJ
author Al Jawder S
AlJishi E
Al-Otaibi S
Al-Shahrani MS
spellingShingle Al Jawder S
AlJishi E
Al-Otaibi S
Al-Shahrani MS
All guns blazing: management and survival of massive valproic acid overdose – case report and literature review
Open Access Emergency Medicine
Valproic acid
multiple dose activated charcoal
L-carnitine
hemodialysis
author_facet Al Jawder S
AlJishi E
Al-Otaibi S
Al-Shahrani MS
author_sort Al Jawder S
title All guns blazing: management and survival of massive valproic acid overdose – case report and literature review
title_short All guns blazing: management and survival of massive valproic acid overdose – case report and literature review
title_full All guns blazing: management and survival of massive valproic acid overdose – case report and literature review
title_fullStr All guns blazing: management and survival of massive valproic acid overdose – case report and literature review
title_full_unstemmed All guns blazing: management and survival of massive valproic acid overdose – case report and literature review
title_sort all guns blazing: management and survival of massive valproic acid overdose – case report and literature review
publisher Dove Medical Press
series Open Access Emergency Medicine
issn 1179-1500
publishDate 2018-01-01
description 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
topic Valproic acid
multiple dose activated charcoal
L-carnitine
hemodialysis
url https://www.dovepress.com/all-guns-blazing-management-and-survival-of-massive-valproic-acid-over-peer-reviewed-article-OAEM
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