Acute liver impairment after sodium valproate overdose

Area of Science:

• Clinical Toxicology
• Pharmacology
• Hepatology

Background:

• Liver impairment is a known adverse effect of long-term sodium valproate (Epilim) therapy.
• Reports of acute liver injury following sodium valproate overdose are infrequent.
• This study addresses the gap in understanding the hepatotoxic potential of acute sodium valproate overdose.

Purpose of the Study:

• To report a case of acute liver injury following a deliberate overdose of sodium valproate.
• To investigate the clinical course and biochemical changes associated with severe sodium valproate overdose.
• To assess the efficacy of supportive management in cases of drug-induced hepatocellular injury.

Main Methods:

• A case report of a 36-year-old female patient who ingested 32 g of sodium valproate.
• Monitoring of serum valproate concentrations and elimination half-life.
• Serial assessment of liver biochemistry tests, including alanine aminotransferase (ALT).

Main Results:

• The patient achieved a peak serum valproate concentration of 4370 μmol/l (630 mg/l) at 4.3 hours post-ingestion, with an elimination half-life of 14.1 hours.
• Initially normal liver biochemistry tests progressively worsened, with the highest ALT level reaching 761 U/l at 2.3 days post-ingestion.
• Full recovery of liver function was achieved with supportive measures alone.

Conclusions:

• Acute sodium valproate overdose can precipitate significant hepatocellular injury.
• Hepatotoxicity may occur even in individuals without pre-existing liver conditions.
• Supportive care is a viable and effective strategy for managing acute sodium valproate-induced liver damage.