Summary

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.