Valproate is a commonly used antiepileptic drug for the treatment of generalized and partial seizures. It is safe for use in both adults and children more than three years of age. It came to the market in 1978, and since then its use has broadened to include the treatment of bipolar and schizoaffective disorders, neuropathic pain, and prophylactic treatment of migraines. Valproate toxicity can occur both accidentally and intentionally. Toxicity can occur with dose adjustments to reach the therapeutic level, in patients with metabolic derangements, with drug-drug interactions, or in attempts to cause self-harm.
Acute valproate overdose usually presents with CNS depression/encephalopathy, electrolyte abnormalities such as hypernatremia, elevated transaminase levels, hyperammonemia, and hepatoxicity. Patients with a severe overdose of valproate, patients can present with hypotension, tachycardia, respiratory depression, metabolic acidosis, cerebral edema, and valproate-related hyperammonemic encephalopathy which may progress to coma and death, if not treated aggressively. It
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