Valproic Acid Overdose and L-Carnitine Therapy

Published: Journal of Analytical Toxicology, Volume 20, Number 1, January/February 1996, pp. 55-58.

Case Report:

Valproic Acid Overdose and L-Carnitine Therapy
Hiroyasu Ishikura, Nobuaki Matsuo, Mineo Matsubara, Takashi Ishihara, Naoshi Takeyama, and Takaya Tanaka

A healthy, nonepileptic 16-month-old child ingested a massive overdose (approximately 4000 mg) of valproic acid (VPA). Upon admission to the hospital, he was in a deep coma and had generalized hypotonicity and no response to pain. His serum and urinary concentrations of VPA were 1316.2 and 3289.5 µg/mL, respectively. Urinary concentrations of the b-oxidation metabolites of VPA were low, whereas concentrations of w- and w1-oxidation metabolites were high. Moreover, 4-en-valproate (a potential hepatotoxin) was detected in the urine. Gastric lavage and general supportive measures were undertaken, including intravenous infusion to increase urine output and oral L-carnitine to correct hypocarnitinemia. Subsequently, the b-oxidation metabolites increased, the w- and w1-oxidation metabolites decreased, and 4-en-valproate was no longer detected. The patient recovered completely and was discharged on the eighth hospital day without any sequelae. This case suggests that enhanced drug excretion and l-carnitine supplementation may prevent potentially fatal hepatic dysfunction after VPA overdose.

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