Valproic acid intoxication – The importance of toxicological analysis and correct management: A case report

Q1 Environmental Science

Toxicology Reports Pub Date : 2025-01-04 DOI:10.1016/j.toxrep.2025.101891

André Valle de Bairros , Karol Andriely de Vargas Paier , Leonardo Corrêa Cardoso , Fernanda Ziegler Reginato , Gustavo Andrade Ugalde , Ivy Bauer Lovatel , Miguel Roehrs

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Abstract

Introduction

Valproic acid (VPA) is an anticonvulsant widely used in treating epilepsy which can occur cases of poisoning in overdose situations.

Case description

A 15-year-old girl purposely ingested about 100 drug tablets according to family members. Gastric lavage with activated charcoal was performed at home using a nasogastric tube and patient just was taken to the hospital around 10 h after drug ingestion, arriving in shock state. All laboratorial parameters were altered together a suspect of aspiration pneumonia with the presence of gross perihilar infiltrated in the right lung. Immunoassay screening test did not detect any substance; LC-UV detected quetiapine (> 150 ng/mL) while GC-MS determined 977.96 µg/mL of valproic acid in the patient’s plasma, confirming valproic acid intoxication. Appropriate life support was performed in the patient during hospitalization; however, she died two days later, reaching her suicide.

Conclusions

Prognosis could be favorable if the patient was taken immediately to hospital emergency, considering the complexity of managing poisoning. Patient´s anamnesis must be carefully analyzed by the healthcare professional to avoid false conclusions and toxicological analysis is extremely important to clarify suspected poisoning.

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丙戊酸中毒-毒理学分析和正确处理的重要性：1例报告。

简介：丙戊酸（VPA）是一种广泛用于治疗癫痫的抗惊厥药，在过量情况下可发生中毒。病例描述：一名15岁的女孩，据其家人说，故意服用了约100片药物。在家中使用鼻胃管进行活性炭洗胃，患者在服药后10 h左右才被送往医院，到达休克状态。所有的实验室参数都改变了，同时怀疑吸入性肺炎，右肺门周围有明显浸润。免疫分析筛选试验未检出任何物质；LC-UV检出喹硫平（> 150 ng/mL）， GC-MS检出丙戊酸977.96 µg/mL，确认丙戊酸中毒。在住院期间给予患者适当的生命支持；然而，两天后她去世了，达到了自杀的目的。结论：考虑到中毒处理的复杂性，如果患者立即送往医院急救，预后可能较好。医疗专业人员必须仔细分析患者的记忆，以避免错误的结论，毒理学分析对澄清疑似中毒非常重要。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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