RESUMEN
BACKGROUND: Valproic acid (VPA) is increasingly used to treat a variety of medical disorders, such as seizures, psychiatric disorders, and headaches. Therefore, accidental and intentional ingestions with valproic acid are increasing. OBJECTIVES: A case is presented in an adolescent with ischemic electrocardiographic changes after an acute overdose with VPA. DISCUSSION: Major features of a valproic acid overdose include respiratory depression, progressive coma, hepatotoxicity, thrombocytopenia, and hemodynamic instability. Electrocardiographic abnormalities usually consist of tachycardia and nonspecific changes. Supportive care is indicated in most overdoses and involves the monitoring and correction of electrolyte abnormalities, coagulopathies, and acid-base imbalances. Treatment may include activated charcoal, naloxone, l-carnitine, and extracorporeal detoxification. CONCLUSIONS: Valproic acid overdose is a relatively rare and electrocardiographic changes usually consist of tachycardia and nonspecific changes, but ischemic changes may occur and usually transient and require only recognition.
Asunto(s)
Anticonvulsivantes/envenenamiento , Antimaníacos/envenenamiento , Sobredosis de Droga/complicaciones , GABAérgicos/envenenamiento , Taquicardia/inducido químicamente , Ácido Valproico/envenenamiento , Adolescente , Anticonvulsivantes/toxicidad , Antimaníacos/toxicidad , Sobredosis de Droga/fisiopatología , Electrocardiografía , Femenino , GABAérgicos/toxicidad , Humanos , Ácido Valproico/toxicidadAsunto(s)
Anticonvulsivantes/envenenamiento , Benzodiazepinas/envenenamiento , Trastornos Relacionados con Sustancias/etiología , Adulto , Síndrome de Asperger/psicología , Sobredosis de Droga , Toxicología Forense , GABAérgicos/envenenamiento , Humanos , Masculino , Detección de Abuso de Sustancias , Trastornos Relacionados con Sustancias/diagnóstico , SueciaRESUMEN
A 31-y-old epileptic man developed coma and shock after suicidally ingesting large amounts of valproic acid and gabapentin. His peak valproic acid, level was 1306.9 micrograms/mL (therapeutic range = 30-100 micrograms/mL). His peak gabapentin level was 60.0 micrograms/mL (therapeutic range = 2.0-8.0 micrograms/mL). His hypotension was refractory to crystalloid and pressor infusions, but resolved during concurrent hemoperfusion and hemodialysis to enhance elimination of valproic acid. Concurrent hemoperfusion and hemodialysis, in series, produced a maximum valproic acid plasma clearance of 55.4 mL/min versus a maximum reported intrinsic valproic acid plasma clearance of 10.6 mL/min. concurrent hemoperfusion and hemodialysis, in series, should be considered in hemodynamically unstable patients with valproic acid poisoning whose clinical condition is worsening in spite of aggressive supportive care.