Valproic acid toxicity - Revision history

Danbot: Fix drug name: use canonical Levocarnitine instead of redirect Levo-carnitine

2026-03-20T17:44:49Z

Fix drug name: use canonical Levocarnitine instead of redirect Levo-carnitine

← Revisión anterior		Revisión del 17:44 20 mar 2026
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	[[Category:Toxicology]		[[Category:Toxicology]
	==Medication Dosing==		==Medication Dosing==
	*{{MedicationDose\|drug=~~Levo-carnitine~~\|dose=100 mg/kg IV bolus, then 50 mg/kg q8hr\|route=IV\|context=Antidote (enhances VPA metabolism)\|indication=Valproic acid toxicity\|population=Adult\|notes=For lethargy, coma, hyperammonemia, hepatic dysfunction}}		*{{MedicationDose\|drug=Levocarnitine\|dose=100 mg/kg IV bolus, then 50 mg/kg q8hr\|route=IV\|context=Antidote (enhances VPA metabolism)\|indication=Valproic acid toxicity\|population=Adult\|notes=For lethargy, coma, hyperammonemia, hepatic dysfunction}}
	*{{MedicationDose\|drug=Naloxone\|dose=0.4-2 mg, may repeat\|route=IV\|context=Reversal of CNS depression\|indication=Valproic acid toxicity\|population=Adult\|notes=May reverse CNS depression by unclear mechanism}}		*{{MedicationDose\|drug=Naloxone\|dose=0.4-2 mg, may repeat\|route=IV\|context=Reversal of CNS depression\|indication=Valproic acid toxicity\|population=Adult\|notes=May reverse CNS depression by unclear mechanism}}

	]		]

Danbot: Add MedicationDose SMW entries for levo-carnitine and naloxone; doses verified against toxicology references

2026-03-20T17:39:07Z

Add MedicationDose SMW entries for levo-carnitine and naloxone; doses verified against toxicology references

← Revisión anterior		Revisión del 17:39 20 mar 2026
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	<references/>		<references/>

	[[Category:Toxicology]]		[[Category:Toxicology]
			==Medication Dosing==
			*{{MedicationDose\|drug=Levo-carnitine\|dose=100 mg/kg IV bolus, then 50 mg/kg q8hr\|route=IV\|context=Antidote (enhances VPA metabolism)\|indication=Valproic acid toxicity\|population=Adult\|notes=For lethargy, coma, hyperammonemia, hepatic dysfunction}}
			*{{MedicationDose\|drug=Naloxone\|dose=0.4-2 mg, may repeat\|route=IV\|context=Reversal of CNS depression\|indication=Valproic acid toxicity\|population=Adult\|notes=May reverse CNS depression by unclear mechanism}}

			]

ClaireLewis at 21:20, 13 February 2021

2021-02-13T21:20:00Z

← Revisión anterior		Revisión del 21:20 13 feb 2021
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	==Clinical Features==		==Clinical Features==
	*CNS depression		*[[AMS\|CNS depression]]
	*Ataxia		*[[Ataxia]]
	*Hypotension		*[[Hypotension]]
	*Respiratory depression		*Respiratory depression

Línea 14:		Línea 14:
	*Chemistry		*Chemistry
	**[[Hypocalcemia]], [[hypernatremia]], [[hypophosphatemia]], AG [[metabolic acidosis]]		**[[Hypocalcemia]], [[hypernatremia]], [[hypophosphatemia]], AG [[metabolic acidosis]]
	*~~LFT~~		*[[LFTs]]
	**Elevated transaminases		**Elevated transaminases
	*Hyperammonemia		*[[Hyperammonemia]]
	**Can be asymptomatic or cause Valproate associated Hepatic Encephalopathy (VPE)		**Can be asymptomatic or cause Valproate associated [[Hepatic Encephalopathy]] (VPE)
	**Secondary to L-Carnitine and Acetyl-CoA depletion which inhibits urea cycle		**Secondary to L-Carnitine and Acetyl-CoA depletion which inhibits urea cycle
	**Can be seen with therapeutic VPA levels and normal LFTs		**Can be seen with therapeutic VPA levels and normal LFTs
Línea 34:		Línea 34:
	*May be effective in reversing CNS depression by unclear mechanism<ref>Roberge R. et al. Use of naloxone in valproic acid overdose: case report and review. J Emerg Med. 2002 Jan;22(1):67-70.</ref><ref>Thanacoody HK. Chronic valproic acid intoxication: reversal by naloxone. Emerg Med J. 2007 Sep. 24(9):677-8.</ref>		*May be effective in reversing CNS depression by unclear mechanism<ref>Roberge R. et al. Use of naloxone in valproic acid overdose: case report and review. J Emerg Med. 2002 Jan;22(1):67-70.</ref><ref>Thanacoody HK. Chronic valproic acid intoxication: reversal by naloxone. Emerg Med J. 2007 Sep. 24(9):677-8.</ref>

	===Dialysis===		===[[Dialysis]]===
	*Effective but reserved for severe overdoses (VPA level >500 mcg/mL) and refractory hemodynamic instability and metabolic acidosis that do not respond to fluid resuscitation<ref>Tank JE. et al. Simultaneous "in series" hemodialysis and hemoperfusion in the management of valproic acid overdose. Am J Kidney Dis. 1993 Aug. 22(2):341-4. </ref>		*Effective but reserved for severe overdoses (VPA level >500 mcg/mL) and refractory hemodynamic instability and metabolic acidosis that do not respond to fluid resuscitation<ref>Tank JE. et al. Simultaneous "in series" hemodialysis and hemoperfusion in the management of valproic acid overdose. Am J Kidney Dis. 1993 Aug. 22(2):341-4. </ref>

Elcatracho: /* Clinical Features */

2021-02-13T20:14:08Z

Clinical Features

← Revisión anterior		Revisión del 20:14 13 feb 2021
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	==Clinical Features==		==Clinical Features==
	*CNS depression		*CNS depression
			*Ataxia
	*Hypotension		*Hypotension
	*Respiratory depression		*Respiratory depression

Elcatracho: /* Evaluation */

2021-02-13T20:13:28Z

Evaluation

← Revisión anterior		Revisión del 20:13 13 feb 2021
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	==Evaluation==		==Evaluation==
	*Level		*Level
	**Does not correlate well with toxicity		**Does not correlate well with toxicity (can be therapeutic with toxicity)
	**Adverse effects increase with level >150		**Adverse effects increase with level >150
	*Chemistry		*Chemistry

NadavNahumi: /* Dialysis */

2020-03-20T21:55:43Z

Dialysis

← Revisión anterior		Revisión del 21:55 20 mar 2020
Línea 34:		Línea 34:

	===Dialysis===		===Dialysis===
	*Effective but reserved for severe overdoses and refractory hemodynamic instability and metabolic acidosis that do not respond to fluid resuscitation<ref>Tank JE. et al. Simultaneous "in series" hemodialysis and hemoperfusion in the management of valproic acid overdose. Am J Kidney Dis. 1993 Aug. 22(2):341-4. </ref>		*Effective but reserved for severe overdoses (VPA level >500 mcg/mL) and refractory hemodynamic instability and metabolic acidosis that do not respond to fluid resuscitation<ref>Tank JE. et al. Simultaneous "in series" hemodialysis and hemoperfusion in the management of valproic acid overdose. Am J Kidney Dis. 1993 Aug. 22(2):341-4. </ref>

	==Disposition==		==Disposition==

ClaireLewis: /* Levo-carnitine */

2016-10-19T17:03:34Z

Levo-carnitine

← Revisión anterior		Revisión del 17:03 19 oct 2016
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	*[[Activated charcoal]] PO x1 or [[multidose activated charcoal]] (for delayed-release preparations)		*[[Activated charcoal]] PO x1 or [[multidose activated charcoal]] (for delayed-release preparations)

	===Levo-carnitine===		===[[Levo-carnitine]]===
	*Increases valproate metabolism and recommended for patients with:		*Increases valproate metabolism and recommended for patients with:
	**Lethargy, coma, VPA associated hyperammonemic encephalopathy, hepatic dysfunction		**Lethargy, coma, VPA associated hyperammonemic encephalopathy, hepatic dysfunction
	**100mg/kg IV bolus, followed by 50mg/kg Q8h or alternatively 50mg/kg/day IV in 3 divided doses<ref>Ishikura H. et al. Valproic acid overdose and L-carnitine therapy. J Anal Toxicol. 1996 Jan-Feb. 20(1):55-8.</ref><ref>Russell S. Carnitine as an antidote for acute valproate toxicity in children. Curr Opin Pediatr. 2007 Apr. 19(2):206-10.</ref>		**100mg/kg IV bolus, followed by 50mg/kg Q8h or alternatively 50mg/kg/day IV in 3 divided doses<ref>Ishikura H. et al. Valproic acid overdose and L-carnitine therapy. J Anal Toxicol. 1996 Jan-Feb. 20(1):55-8.</ref><ref>Russell S. Carnitine as an antidote for acute valproate toxicity in children. Curr Opin Pediatr. 2007 Apr. 19(2):206-10.</ref>

	===[[Naloxone]]===		===[[Naloxone]]===
	*May be effective in reversing CNS depression by unclear mechanism<ref>Roberge R. et al. Use of naloxone in valproic acid overdose: case report and review. J Emerg Med. 2002 Jan;22(1):67-70.</ref><ref>Thanacoody HK. Chronic valproic acid intoxication: reversal by naloxone. Emerg Med J. 2007 Sep. 24(9):677-8.</ref>		*May be effective in reversing CNS depression by unclear mechanism<ref>Roberge R. et al. Use of naloxone in valproic acid overdose: case report and review. J Emerg Med. 2002 Jan;22(1):67-70.</ref><ref>Thanacoody HK. Chronic valproic acid intoxication: reversal by naloxone. Emerg Med J. 2007 Sep. 24(9):677-8.</ref>

Rossdonaldson1: Text replacement - "assoc " to "associated "

2016-08-24T20:22:48Z

Text replacement - "assoc " to "associated "

← Revisión anterior		Revisión del 20:22 24 ago 2016
Línea 27:		Línea 27:
	===Levo-carnitine===		===Levo-carnitine===
	*Increases valproate metabolism and recommended for patients with:		*Increases valproate metabolism and recommended for patients with:
	**Lethargy, coma, VPA ~~assoc~~ hyperammonemic encephalopathy, hepatic dysfunction		**Lethargy, coma, VPA associated hyperammonemic encephalopathy, hepatic dysfunction
	**100mg/kg IV bolus, followed by 50mg/kg Q8h or alternatively 50mg/kg/day IV in 3 divided doses<ref>Ishikura H. et al. Valproic acid overdose and L-carnitine therapy. J Anal Toxicol. 1996 Jan-Feb. 20(1):55-8.</ref><ref>Russell S. Carnitine as an antidote for acute valproate toxicity in children. Curr Opin Pediatr. 2007 Apr. 19(2):206-10.</ref>		**100mg/kg IV bolus, followed by 50mg/kg Q8h or alternatively 50mg/kg/day IV in 3 divided doses<ref>Ishikura H. et al. Valproic acid overdose and L-carnitine therapy. J Anal Toxicol. 1996 Jan-Feb. 20(1):55-8.</ref><ref>Russell S. Carnitine as an antidote for acute valproate toxicity in children. Curr Opin Pediatr. 2007 Apr. 19(2):206-10.</ref>
	===[[Naloxone]]===		===[[Naloxone]]===

Neil.m.young: Text replacement - "==Diagnosis==" to "==Evaluation=="

2016-07-27T03:15:29Z

Text replacement - "==Diagnosis==" to "==Evaluation=="

← Revisión anterior		Revisión del 03:15 27 jul 2016
Línea 7:		Línea 7:
	*Respiratory depression		*Respiratory depression

	==~~Diagnosis~~==		==Evaluation==
	*Level		*Level
	**Does not correlate well with toxicity		**Does not correlate well with toxicity

Rossdonaldson1: Text replacement - "w/ " to "with "

2016-07-14T11:13:39Z

Text replacement - "w/ " to "with "

← Revisión anterior		Revisión del 11:13 14 jul 2016
Línea 9:		Línea 9:
	==Diagnosis==		==Diagnosis==
	*Level		*Level
	**Does not correlate well w/ toxicity		**Does not correlate well with toxicity
	**Adverse effects increase w/ level >150		**Adverse effects increase with level >150
	*Chemistry		*Chemistry
	**[[Hypocalcemia]], [[hypernatremia]], [[hypophosphatemia]], AG [[metabolic acidosis]]		**[[Hypocalcemia]], [[hypernatremia]], [[hypophosphatemia]], AG [[metabolic acidosis]]