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Unrecognized valproic acid intoxication.

April C Hurdle1, Ryan D Moss

  • 1Department of Pharmacy, Methodist University Hospital, Memphis, TN 38104, USA. achurdle@bellsouth.net

The American Journal of Emergency Medicine
|April 18, 2009
PubMed
Summary
This summary is machine-generated.

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Acute valproic acid (VPA) intoxication was unrecognized in a schizophrenia patient presenting with altered mental status. This case highlights the need for emergency physicians to consider VPA toxicity in patients with psychiatric conditions.

Area of Science:

  • Neuroscience
  • Clinical Toxicology
  • Psychiatry

Background:

  • Anticonvulsant medications, such as valproic acid (VPA), are frequently prescribed for psychiatric conditions, including schizophrenia.
  • Patients with psychiatric conditions may be at higher risk for medication non-adherence or intentional overdose.

Purpose of the Study:

  • To report a case of acute valproic acid (VPA) intoxication that was initially misdiagnosed and treated as nonconvulsive seizures.
  • To emphasize the importance of considering VPA toxicity in patients with altered mental status, especially those with psychiatric comorbidities.

Main Methods:

  • Case report of a 28-year-old male patient with schizophrenia presenting to the emergency department with altered mental status.
  • Initial diagnostic workup included a head CT and EEG, which were inconclusive for seizures.

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  • Intravenous VPA was administered before serum VPA concentration results were available, revealing acute intoxication.

    • Main Results:

    • The patient's serum VPA concentration was significantly elevated (initial level >300 microg/mL, rising to 423 microg/mL).
    • The patient reported a suicide attempt involving ingestion of an unknown quantity of VPA.
    • The initial presentation of altered mental status was attributed to VPA toxicity, not nonconvulsive seizures.

    Conclusions:

    • Acute VPA intoxication can mimic neurological emergencies like nonconvulsive seizures in patients with schizophrenia.
    • Emergency physicians must maintain a high index of suspicion for VPA toxicity in patients presenting with mental status changes, particularly those with psychiatric histories.
    • Prompt VPA level monitoring is crucial for accurate diagnosis and management in patients receiving this medication.