Yoğun Bakım Ünitesinde Valproik Asit Kaynaklı Ciddi Toksisite Tedavisinde Hemodiyaliz, Levokarnitin ve Meropenem Uygulaması

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Şahin C. N. D., Yıldız N., Bakal H., Eroğlu A.

Farabi Medical Journal, vol.2, no.2, pp.23-26, 2023 (Peer-Reviewed Journal)


Introduction:  Valproic acid (VPA) is currently a drug that can be 

used in the prophylaxis of epilepsy, bipolar disorder, schizoaffective 

disorder, schizophrenia and migraine. Valproic acid poisoning can 

result in central nervous system depression, shock, acute 

hyperammonemia, cerebral edema, coma and death. In this case, we 

wanted to present a patient who was treated with levocarnitine, 

hemodialysis and meropenem due to severe VPA toxicity.

Case:  A 41-year-old male patient was firstly brought to the 

emergency room and  then Intensive Care Unit with confusion. The 

patients was intubated because of his Glasgow Coma Score of 6 and 

respiratory failure. The patient had tachycardia, hypotension, and 

needed vasopressor medication. While liver function tests were 

found to be normal, hyperammonemia was thought to be drug-related. The patient's blood valproate level was 1055mg/L 

(therapeutic normal range: 50-100mg/L). The patient who developed 

aspiration pneumonia was given meropenem, which was found to be 

beneficial in valproic acid intoxication. Clinical manifestations of 

valproic acid poisoning are central nervous system depression, 

respiratory depression, hypotension, metabolic acidosis, bone 

marrow failure, brain edema, hypoglycemia, hypernatremia, and 

hyperammonemia. Treatment  of acute valproic acid poisoning 

usually includes supportive care and fluid therapy, vasopressor 

support, electrolyte imbalance, and correction of acid-base 

disorders. Since the initial valproate level was 1055 uq/ml in our 

case, we applied to hemodialysis as the first treatment. We used 

levocarnitine especially because it can be useful in 


Conclusion:  As a result, we observed that combined treatment of 

hemodialysis, levocarnitine and meropenem rapidly decreased the 

valproic acid level and resulted in a successful recovery.

Keywords:  Valproic acid, Intoxication, Levocarnitine