Akademik Veri Yönetim Sistemi
Farabi Medical Journal, cilt.2, sa.2, ss.23-26, 2023 (Hakemli Dergi)
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
hyperammonemia.
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