Unexpected outcome (positive or negative) including adverse drug reactions
Acute liver impairment after sodium valproate overdose
The Royal Infirmary of Edinburgh, Scottish Poisons Information Bureau, 51 Little France Crescent, Edinburgh EH16 4SA, UK
Correspondence to:
William Stephen Waring, s.waring{at}ed.ac.uk
Liver impairment is a recognised adverse effect of long-term sodium valproate treatment, but there are few reports concerning its occurrence after acute overdose. This report describes a 36-year-old woman who deliberately ingested 32 g of sodium valproate (Epilim). Serum valproate concentration was 4370 µmol/l (630 mg/l) at 4.3 h post-ingestion (therapeutic reference range: 300–600 µmol/l), and the elimination half-life was 14.1 h. Liver biochemistry tests were initially normal but gradually became impaired, and highest alanine aminotransferase (761 U/l) occurred 2.3 days after ingestion. Supportive measures alone were sufficient to allow recovery of liver function. This case indicates that sodium valproate overdose may cause acute hepatocellular injury, even in the absence of pre-existing liver disease.
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