An overdose of valproic acid can result in a serious mulit-systemic disorder.
Clinical findings during an overdose may include:
(1) hyperammonemic encephalopathy
(2) hepatototoxicity with elevated serum transaminases
(3) pancreatitis
(4) heart block
(5) acute renal failure
(6) alopecia
(7) optic nerve atrophy
The clinical picture of encephalopathy and hepatocellular failure may resemble Reye's syndrome.
Laboratory findings:
(1) hypernatremia
(2) respiratory alkalosis followed by metabolic acidosis
(3) increased anion and osmolal gaps
(4) hypocalcemia
(5) bone marrow depression with anemia, leukopenia and/or thrombocytopenia
(6) normal to elevated serum valproic acid concentration (absence of an elevated valporic acid level does not exclude the diagnosis)
A metabolite 2-propyl-2-pentenoic acid is a neurotoxin that may accumulate and cause neurotoxicity. This should be suspected when the serum valproic acid levels are normal.
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