Acute-on-Chronic Valproic Acid Overdose: A Toxicology Simulation Case for Medical Students

Overdose of valproic acid, an antiepileptic medication prescribed for seizure disorders, bipolar disorder, and migraine prophylaxis, is common but underrepresented in medical school curricula. Because valproic acid is widely prescribed and toxicity can occur at both therapeutic and supratherapeutic doses, medical students need a foundation in recognizing and managing it. To close this gap, we built a multimodal educational intervention combining didactic instruction with an experiential simulation.

Fourth-year toxicology elective students completed a knowledge pretest and a confidence-based Likert questionnaire before attending a lecture, then worked in small groups through a 15-minute simulated encounter with a patient with acute-on-chronic valproic acid overdose, followed by a 15-minute debrief. The scenario's critical actions comprised a focused history, neurologic exam, valproic acid and ammonia levels, L-carnitine administration, and toxicology/psychiatry consultation; required materials were a manikin, intravenous supplies, and pharmaceuticals. A posttest and follow-up Likert questionnaires captured knowledge change, reactions, and intended practice change.

Across 10 sessions, 48 students completed both tests; scores rose from a mean of 58% (SD = 21%) to 97% (SD = 6%) (Wilcoxon W = 0.0; P < .001), and every group completed the critical actions checklist. Confidence in all four domains (identifying manifestations, obtaining diagnostic studies, interpreting diagnostic studies, and initiating treatment) rose from a median of 3-4 to 5 (Mann-Whitney P < .001 for all). Reactions to the workshop were favorable, and most learners reported intent to change practice.

This multimodal simulation was an effective way to teach valproic acid overdose management.