title: [Acidosis and hyperlactatemia in acute sodium valproate poisoning].
abstract: OBJECTIVE
  We searched for signs of metabolic acidosis and associated hyperlactatemia in case of sodium valproate overdose.
  
  
  METHODS
  A retrospective study was conducted in the toxicology intensive care unit at the Fernand Widal hospital from 1990 to 1995. Patients retained for study had sodium valproate levels above the therapeutic range (> 600 mumol/l). Data collected included past history, intubation for mechanical ventilation, administration of catecholamines and infusion of bicarbonate or sodium lactate, and blood pressure. Laboratory tests included serum sodium valproate, pH, PCO2, bicarbonate, anion balance and lactate.
  
  
  RESULTS
  The study included 22 consecutive patients. None had a history of liver disease. Thirteen patients were intubated before admission to intensive care. Two received catecholamines. None of the patients received bicarbonate or sodium lactate. Mean blood pressure was 118 +/- 16 mmHg, mean serum sodium valproate was 2668 +/- 2437 mumol/l, mean pH was 7.41 +/- 0.08, mean PO2 35.6 +/- 8.0, mean anion imbalance 23.2 +/- 6.0 mmol/l and mean lactate 5.0 +/- 2.1 mmol/l. There was a significant correlation between lactase and pH (p < 0.003).
  
  
  CONCLUSIONS
  We found metabolic acidosis with major anion imbalance and high lactate levels in patients with acute sodium valproate intoxication. Hyperlactatemia could be due to the direct effect of sodium valproate or to an unknown mechanism.
authors.affiliation: Service de Réanimation toxicologique, Université Paris VII, Hôpital Fernand Widal, Paris.
authors.forename: A
authors.initials: A
authors.lastname: Dumoulin
authors.forename: F
authors.initials: F
authors.lastname: Lapostolle
authors.forename: F
authors.initials: F
authors.lastname: Adnet
authors.forename: J
authors.initials: J
authors.lastname: Muzynski
authors.forename: F J
authors.initials: FJ
authors.lastname: Baud
mesh_terms: D000138:Acidosis / Q000209:etiology*; D000208:Acute Disease; D000328:Adult; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007773:Lactates / Q000097:blood*; D008297:Male; D012189:Retrospective Studies; D014635:Valproic Acid / Q000506:poisoning*
chemical_list: D007773:Lactates; D014635:Valproic Acid
vernacular_title: Acidose et hyperlactatémie lors des intoxications aiguës par le valproate de sodium.