Lee W L, Yang C C, Deng J F, Chen Y F, Lin H D, Wang P H
Department of Medicine, Veterans General Hospital, Taipei.
Vet Hum Toxicol. 1998 Dec;40(6):346-8.
Although valproic acid has gradually gained its popularity in the treatment of various seizure disorders, overdose of valproate is not common. An 18-y-old man with a history of epilepsy controlled by sodium valproate and clonazepam attempted suicide with an ingestion of 45 g sodium valproate. He presented to our service with drowsiness and irritability. Extremely high serum ammonia (623 ug/dL) and elevated serum valproate concentration (575 ug/mL) were found on admission. Several metabolic abnormalities, including hypernatremia, hypocalcemia and metabolic acidosis, as well as, increased serum transaminase levels were also recorded. With supportive measures, he became clear 24 h later and was discharged 6 d after ingestion. Serial follow-up of his serum valproate and ammonia levels disclosed a close relationship between these 2 measurables. After acute overdose of valproic acid, patients usually present with mild and generally reversible depression of the central nervous system. However, impairment of liver function, hyperammonemia, fluid-electrolyte disturbances, coma, seizures, hypotension and even death may occur following valproate overdose. Symptomatic and supportive measures are the mainstay in the treatment of valproic acid overdose. With prompt diagnosis and early institution of treatment, a complete recovery should be anticipated.
尽管丙戊酸在各种癫痫疾病的治疗中逐渐受到欢迎，但丙戊酸盐过量并不常见。一名18岁男性，有癫痫病史，服用丙戊酸钠和氯硝西泮控制病情，他试图服用45克丙戊酸钠自杀。他因嗜睡和易怒前来就诊。入院时发现血清氨水平极高（623微克/分升），血清丙戊酸盐浓度升高（575微克/毫升）。还记录到了几种代谢异常情况，包括高钠血症、低钙血症和代谢性酸中毒，以及血清转氨酶水平升高。经过支持治疗，他在24小时后清醒，摄入药物6天后出院。对他的血清丙戊酸盐和氨水平进行的系列随访揭示了这两个可测量指标之间的密切关系。急性丙戊酸过量后，患者通常表现为中枢神经系统轻度且一般可逆的抑制。然而，丙戊酸盐过量后可能会出现肝功能损害、高氨血症、水电解质紊乱、昏迷、癫痫发作、低血压甚至死亡。对症和支持治疗是丙戊酸过量治疗的主要方法。通过及时诊断和早期治疗，可以预期患者会完全康复。
