Massive valproic acid overdose, a misleading case

Sikma, Maaike MD
Mier, J. C. MD
Meulenbelt, J. MD, PhD

Department of Intensive Care, University Medical Centre Utrecht, P.O. Box 85500, 3508 GA Utrecht, The Netherlands (Sikma, Meulenbelt)
Department of Anesthesiology, University Medical Centre Utrecht, P.O. Box 85500, 3508 GA Utrecht, The Netherlands (Mier)
National Poisons Information Centre Of National Institute for Public Health and the Environment, P.O. Box 1, 3720 BA Bilthoven, The Netherlands (Meulenbelt)

E-mail address:[email protected]; [email protected].

Received for publication May 29, 2007; accepted June 16, 2007

American Journal of Emergency Medicine 26(1):p 110e3-110e6, January 2008.

Seizures are often attributed to a low plasma concentration of antiepileptic drugs, although sometimes it can be due to a high plasma concentration of the antiepileptic drug. This case report describes a very severe valproic acid intoxication including paradoxical seizures, which was initially held for a subtherapeutic valproic acid treatment. Applied treatment strategy based on available evidence is discussed. A more careful clinical evaluation at admission might have guided the treating physicians to the right diagnoses from the start. The important lesson is that several antiepileptic medicines, as valproic acid, can cause seizures in overdose.