Abstract

Suzan Nasser, Haia Na, Soboh Soboh, Abo Zed Saed, Kobi Monovich, Ehsan N. and Wael Nasser*

ABSTRACT

Valproic acid is an anti-epileptic drug used to treat partial and generalized seizures, acute mania, as prophylaxis for bipolar disorder and migraine headaches. The mechanism of action of valproic acid is its ability to potentiate the effect of neurotransmitter Gamma Amino Butyrate (GABA). Valproic acid intoxication may lead to central nervous system depression, encephalopathy, respiratory depression, hypotension, bone marrow depression, acid-base disorders, hyperammonemia, and elevated liver enzymes. Several methods had been suggested to treat valproic acid intoxication, like supportive treatment, naloxone injection, l-carnitine, activated charcoal, and hemofiltration .In this article, we report a case wherein an eight-year-old girl was treated for one week with three fold the prescribed dose of valproic acid. She suffered from drowsiness, abdominal pain, vomiting, and diarrhea. Her blood tests showed her valproic acid level double the upper limit of normal level in blood and a mild elevation of ammonia. She was treated by discontinuing the medicine, supportive treatment and recurrent doses of activated charcoal. The levels of valproic acid and ammonia returned to normal along with improvement in her clinical condition.While cases of chronic valproic acid intoxication have been reported, no cases of treatment with recurrent doses of activated charcoal for mild chronic valproic acid intoxication has been found in the literature.