Kato Taichi, Hiyama Shunki, Sano Mirai, Nakamura Gen, Sugiyama Kazuhiro
Tertiary Emergency Medical Center, Tokyo Metropolitan Bokutoh Hospital, Tokyo, JPN.
Cureus. 2024 Jul 23;16(7):e65165. doi: 10.7759/cureus.65165. eCollection 2024 Jul.
Valproic acid is commonly used for treating seizures and psychiatric disorders. Valproic acid is a common anticonvulsant drug causing overdose for suicidal purposes. The most common symptom of valproic acid poisoning is central nervous system damage. Most cases result in mild to moderate drowsiness, while in severe cases, fatal cerebral edema and coma have been reported. Other complications include respiratory depression, hepatotoxicity, thrombocytopenia, and multi-organ failure resulting in circulatory collapse. Herein, we present a case of a 42-year-old woman who ingested an overdose of 600 mg nitrazepam, 50 mg olanzapine, and 35,600 mg valproic acid. The maximum daily doses for nitrazepam, olanzapine, and valproic acid are 15, 20, and 1200 mg, respectively. This overdose led to reversible arginine vasopressin (AVP) deficiency as a rare but significant complication. The deficiency led to polyuria with dilute urine, which was effectively suppressed by AVP administration. This case highlights the potential for reversible AVP deficiency as a rare but significant complication of valproic acid overdose. Early diagnosis and appropriate management are crucial for favorable outcomes.
丙戊酸常用于治疗癫痫和精神疾病。丙戊酸是一种常见的抗惊厥药物，常被用于自杀性过量服药。丙戊酸中毒最常见的症状是中枢神经系统损伤。大多数病例会导致轻度至中度嗜睡，而在严重情况下，曾有致命性脑水肿和昏迷的报道。其他并发症包括呼吸抑制、肝毒性、血小板减少以及导致循环衰竭的多器官功能衰竭。在此，我们报告一例42岁女性，她过量服用了600毫克硝西泮、50毫克奥氮平和35600毫克丙戊酸。硝西泮、奥氮平和丙戊酸的最大日剂量分别为15毫克、20毫克和1200毫克。此次过量服药导致了一种罕见但严重的并发症——可逆性精氨酸加压素（AVP）缺乏。这种缺乏导致多尿和低比重尿，通过给予AVP得到了有效抑制。该病例凸显了可逆性AVP缺乏作为丙戊酸过量服用一种罕见但严重并发症的可能性。早期诊断和适当治疗对于取得良好预后至关重要。
