Sodium Valproate

Question 1

Risk Assessment

Answer 1

1000mg/kg

• potentially lethal
• prolonged coma
• cerebral edema
• metabolic: lactic acidosis/ hypoglycaemia/ hypocalcaemia/ hyperammonaemia/ hypernatremia/
• bone marrow suppression
• CVS unstable: arrhythmia/ hypotension/ arrest
• Renal impairment

Question 2

Ix

Answer 2

Specific

• serial Valproate levesl q4-6 hr IF >400mg/kg
• determine need for dialysis
• FBE
• UEC
• CMP
• ABG

Question 3

Serum levels

Answer 3

500mg/L- coma & multi organ effects
>1000 mg/L- life threatening multi organ
> 2000mg/L- death without urgent hemodialysis

Question 4

Management

Answer 4

Life Threats

• coma
• CVS instability
• multiorgan failure

A/B: if coma
C: supportive

Question 5

Decontamination

Answer 5

AC IF > 400mg/kg
after ETT

Repeat dose at 3-4 hrs may reduce absorption & serum peak levels

Question 6

Enhanced Elimination

Answer 6

Haemodialysis indications:

• > 1000mg/kg ingested & serum level > 1000mg/L
• Serum level > 1500 mg/L at any point
• lactic acidosis
• CVS unstable

Perform before multi organ failure

Question 7

Antidotes

Answer 7

none