Acute valproate ingestion induces symptomatic methemoglobinemia.
A wide variety of clinical outcomes have been described after acute valproate ingestion. We report for the first time the development of symptomatic methemoglobinemia after an acute ingestion of divalproex sodium (Depakote), resulting in serum concentrations 10 times greater than the therapeutic range. The methemoglobinemia was readily reversed with the administration of methylene blue. Valproate elimination was enhanced by the continuous infusion of activated charcoal. The patient recovered without permanent sequelae.
Lynch
A
A
Division of Pediatric Critical Care and Anesthesia, Vanderbilt University, Nashville, Tennessee, USA.
Tobias
J D
JD
D000208:Acute Disease; D000931:Antidotes / Q000627:therapeutic use; D002606:Charcoal / Q000627:therapeutic use; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008708:Methemoglobinemia / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy; D008751:Methylene Blue / Q000627:therapeutic use; D011041:Poisoning / Q000628:therapy; D014635:Valproic Acid / Q000506:poisoning*
D000931:Antidotes; D002606:Charcoal; D014635:Valproic Acid; D008751:Methylene Blue