Rare disease
Chronic valproic acid intoxication: reversal by naloxone
Scottish Poisons Information Bureau, Royal Infirmary Edinburgh, 51 Little France Crescent, Edinburgh, UK
Correspondence to:
H Thanacoody, ruben.thanacoody{at}luht.scot.nhs.uk
A 76-year-old woman being treated with sodium valproate for bipolar depression presented with a 4-day history of acute confusion and tremulousness. She had apnoeic episodes, a reduced conscious level and generalised myoclonic movements. Her plasma valproate concentration was 848 µmol/litre (normal range 300–600 µmol/litre). Administration of naloxone 0.8 mg led to rapid clinical improvement. Naloxone may be useful in reversing the features of chronic valproate toxicity.
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