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Chronic valproic acid intoxication: reversal by naloxone
1Scottish Poisons Information Bureau, Royal Infirmary Edinburgh, 51 Little France Crescent, Edinburgh, UK.
BMJ Case Reports
|June 29, 2011
Summary
Acute confusion and neurological symptoms in a patient on sodium valproate were rapidly reversed by naloxone. This suggests naloxone may be effective in treating chronic valproate toxicity.
Area of Science:
- Neuroscience
- Clinical Pharmacology
- Toxicology
Background:
- Sodium valproate is a common treatment for bipolar disorder.
- Valproate toxicity can manifest with severe neurological symptoms.
- Chronic valproate toxicity poses a significant clinical challenge.
Purpose of the Study:
- To report a case of acute confusion and neurological deterioration due to sodium valproate toxicity.
- To investigate the potential of naloxone as an antidote for valproate toxicity.
Main Methods:
- A case study of a 76-year-old woman with bipolar depression treated with sodium valproate.
- Monitoring of plasma valproate concentration.
- Administration of naloxone and observation of clinical response.
Main Results:
- The patient presented with acute confusion, reduced consciousness, apnoeic episodes, and myoclonic movements.
- Plasma valproate concentration was significantly elevated (848 μmol/litre).
- Rapid clinical improvement was observed following naloxone administration.
Conclusions:
- Naloxone may be a useful therapeutic agent in reversing the acute neurological manifestations of chronic valproate toxicity.
- This case highlights the importance of recognizing and managing valproate-induced neurotoxicity.
- Further research is warranted to confirm the efficacy of naloxone in valproate toxicity.
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