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Transient Arginine Vasopressin Deficiency Induced by Valproic Acid Intoxication: A Case Report.

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Summary

Valproic acid overdose can cause rare arginine vasopressin (AVP) deficiency, leading to excessive urination. Prompt diagnosis and treatment of this AVP deficiency are vital for patient recovery.

Keywords:
arginine vasopressin deficiencycentral diabetes insipidus (cdi)desmopressinl-carnitinevalproic acid overdose

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Area of Science:

  • Pharmacology
  • Toxicology
  • Endocrinology

Background:

  • Valproic acid is a widely prescribed anticonvulsant and mood-stabilizing drug.
  • Overdose of valproic acid can lead to severe central nervous system depression, respiratory issues, and multi-organ failure.
  • Rare complications of valproic acid toxicity are not well-documented.

Observation:

  • A 42-year-old woman presented with a massive overdose of valproic acid (35,600 mg), nitrazepam, and olanzapine.
  • The patient developed polyuria with dilute urine, indicative of arginine vasopressin (AVP) deficiency.
  • This AVP deficiency was reversible and effectively managed with AVP administration.

Findings:

  • Massive valproic acid overdose can precipitate a rare, reversible arginine vasopressin (AVP) deficiency.
  • The deficiency manifested as nephrogenic diabetes insipidus, characterized by excessive production of dilute urine.
  • The condition resolved with supportive care and AVP administration, highlighting a unique toxicological effect.

Implications:

  • This case underscores the importance of considering endocrine complications in severe valproic acid poisoning.
  • Early identification and management of AVP deficiency are critical for preventing dehydration and electrolyte imbalances.
  • Further research into the mechanisms underlying valproic acid-induced AVP deficiency is warranted.