[Deep lactic acidosis after valproate self-poisoning].
A sixty-year-old woman was admitted in the ICU after Depamide (Valpromide) self-poisoning (430 mg/kg). Four hours after the ingestion, the patient presented coma (Glagow coma score of 3) with bilateral mydriasis requiring tracheal intubation and mechanical ventilation, hypotension requiring epinephrine infusion (0.9 microg/kg per minute), acidosis and hyperlactatemia (29.7 mmol/l at 12 hours) without any kidney or liver failure. The maximal serum valproic acid concentration measured was 342 mg/l after twelve hours (therapeutic rate: 35-85 mg/l). A continuous infusion of sodium bicarbonate was associated with continuous venovenous haemodiafiltration. Progressive haemodynamic improvement and neurologic recovery leaded to extubation at 36 hours.
Blayac
D
D
Département d'anesthésie-réanimation, hôpital Sainte-Marguerite, 270, boulevard Sainte-Marguerite, 13009 Marseille, France.
Roch
A
A
Michelet
P
P
De Francheschi
E
E
Auffray
J-P
JP
D000927:Anticonvulsants / Q000506:poisoning*; D005260:Female; D015600:Glasgow Coma Scale; D017583:Hemodiafiltration; D006801:Humans; D007262:Infusions, Intravenous; D008875:Middle Aged; D017693:Sodium Bicarbonate / Q000008:administration & dosage / Q000627:therapeutic use; D013406:Suicide, Attempted; D016896:Treatment Outcome; D014635:Valproic Acid / Q000031:analogs & derivatives* / Q000506:poisoning*
D000927:Anticonvulsants; D014635:Valproic Acid; D017693:Sodium Bicarbonate; C004651:dipropylacetamide