Valproic Acid Toxicity: Overview and Management

@article{Sztajnkrycer2002ValproicAT,
  title={Valproic Acid Toxicity: Overview and Management},
  author={Matthew D. Sztajnkrycer},
  journal={Journal of Toxicology: Clinical Toxicology},
  year={2002},
  volume={40},
  pages={789 - 801}
}
  • M. Sztajnkrycer
  • Published 1 January 2002
  • Medicine
  • Journal of Toxicology: Clinical Toxicology
Acute valproic acid intoxication is an increasing problem, accounting for more than 5000 calls to the American Association of Poison Control Centers in 2000. The purpose of this paper is to review the pharmacology and toxicology of valproic acid toxicity. Unlike earlier antiepileptic agents, valproic acid appears to function neither through sodium channel inhibition nor through direct γ-aminobutyric acid agonism, but through an indirect increase in regional brain γ-aminobutyric acid levels… 
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197 Citations

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Carnitine as an antidote for acute valproate toxicity in children
  • S. Russell
  • Medicine
    Current opinion in pediatrics
  • 2007
TLDR
Based on this recent literature, it seems reasonable to use carnitine for documented severe valproic acid toxicity, particularly in cases where patients present with coma, rising ammonia level, or valProic acid levels greater than 450 mg/l.
Carnitine in the treatment of valproic acid-induced toxicity
TLDR
L-carnitine is commonly recommended in severe VPA poisoning, especially in children, although the clinical benefit in terms of liver protection or hastening of recovery from unconsciousness has not been established clearly.
Science review: Carnitine in the treatment of valproic acid-induced toxicity – what is the evidence?
TLDR
Carnitine supplementation during VPA therapy in high-risk patients is now recommended by some scientific committees and textbooks, especially paediatricians, and may also be valuable in those patients who develop VHT or VHE.
Extracorporeal elimination in acute valproic acid poisoning
TLDR
Hemmodialysis appears to be the extracorporeal method of choice to enhance VPA elimination in acute poisoning and should be considered in patients with features of severe VPA poisoning and plasma VPA concentration >850 mg/L, particularly if severe hyperammonemia and electrolyte and acid–base disturbances are present.
Delayed Toxicity of a Patient with Valproic Acid Overdose
TLDR
Activated charcoal, carnitine, naloxone, and hemodialysis/hemoperfusion are potential regimens to decrease absorption, to reverse the toxidromes, and to enhance elimination for patients with VPA poisoning.
Acute Valproate Poisoning: Pharmacokinetics, Alteration in Fatty Acid Metabolism, and Changes During Therapy
TLDR
Central nervous system features were the predominant clinical manifestations, followed by respiratory failure and multiorgan failure, and all patients showed signs of impaired mitochondrial β-oxidation with increase of medium- and long-chain acylcarnitines in serum.
Approach to Acute Valproic Acid Intoxication: A Case Presentation
  • 2017
Key-Words: Valproic acid (VA) is a broad spectrum antiepileptic that is commonly used in epilepsy, mood disorders and migraine prophylaxis.Although it is not encountered frequently, VAintoxication…
Idiosyncratic Valproic Acid–Induced Hepatotoxicity in a Sickle Cell Patient
TLDR
It is revealed the clinical significance of prompt pharmacist identification and management of the potential adverse drug event in a 32-year-old female with a history of sickle cell anemia and cerebral palsy following improvement of transaminitis and abdominal pain on discontinuation of valproic acid therapy.
Severe valproic acid intoxication: case study on the unbound fraction and the applicability of extracorporeal elimination
TLDR
The clinical significance of applying continuous veno-venous haemofiltration in VPA intoxication because of protein-binding saturation is illustrated, and when extracorporeal elimination should be considered is suggested.
Disposition of valproic acid in self-poisoned adults.
TLDR
The pharmacokinetics of valproic acid was studied in five intoxicated patients and barbiturates, chlorprotixene, tricyclic antidepressants, tetrahydrocannabinols and alcohol were detected and measured.
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