A case of valproate intoxication with excessive brain edema

Area of Science:

• Neurology
• Clinical Toxicology

Background:

• Sodium valproate is a widely used antiepileptic drug.
• Generalized cerebral seizures necessitate long-term treatment with sodium valproate.

Observation:

• A patient presented with deep coma and respiratory failure following a large sodium valproate overdose.
• Diagnostic imaging revealed massive cerebral edema, confirmed by computerized tomography (CT) and electroencephalography (EEG).
• Serum valproate concentration was significantly elevated, far exceeding the therapeutic range.

Findings:

• Treatment with sodium thiopental, glycerol, and glucocorticoids was initiated.
• Follow-up CT scans and EEG demonstrated complete resolution of cerebral edema and improved neurological function.
• The patient gradually regained consciousness following treatment.

Implications:

• Acute sodium valproate intoxication poses a risk of developing severe cerebral edema.
• Prompt and aggressive management of cerebral edema is crucial for patient recovery.
• This case underscores the importance of monitoring for and treating cerebral edema in valproate overdose scenarios.