title: Favorable results after conservative management of 316 valproate intoxicated patients.
abstract: BACKGROUND
  Valproic acid (VPA) is an effective antiepileptic drug widely used worldwide. Despite several studies indicating the usefulness of intravenous L-carnitine in the treatment of VPA poisoning, this drug is not readily available in Iran. The aim of this study was to determine whether supportive care without antidote would result in acceptable outcomes in VPA poisoned patients.
  
  
  METHODS
  In an observational, retrospective, single-center case series, all patients >12-year-old with VPA overdose who had referred to a tertiary center between 2009 and 2013 were consecutively enrolled. Patients' demographic and presenting features, physical examinations, clinical management, laboratory data, and outcomes were recorded.
  
  
  RESULTS
  A total of 316 patients were enrolled with pure VPA toxicity. The most common presenting signs/symptoms were drowsiness, nausea and vomiting, vertigo, and headache. In the course of the disease, 14 patients (4.4%) were intubated and three (0.9%) required hemodialysis with mean dialysis sessions of two. Fourteen patients were admitted to Intensive Care Unit, and seizures occurred in five. The initial level of consciousness was lower in patients with poor outcome. The median ingested dose of VPA in patients who required dialysis was significantly higher (20 vs. 6 g; P = 0.006). Multivariate analyses revealed that coma on presentation was associated with a worse outcome (P = 0.001; odds ratio = 61.5, 95% CI = 5.8-646.7).
  
  
  CONCLUSIONS
  Prognosis of VPA poisoned patients appears to be good even with supportive care. According to our study, older age, ingestion of higher amounts of VPA and lower PCO2, HCO3, base excess, and CPK levels prone the patients to more severe toxicities in univariate analysis, but the main poor prognostic factor is coma on presentation in multivariate analysis.
authors.affiliation: Toxicological Research Center, Department of Clinical Toxicology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran ; Excellence Center of Clinical Toxicology, Shahid Beheshti University of Medical Sciences, Iranian Ministry of Health, Tehran, Iran.
authors.forename: Shahin
authors.initials: S
authors.lastname: Shadnia
authors.affiliation: Toxicological Research Center, Department of Clinical Toxicology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran ; Emergency Medicine Management Research Center, Iran University of Medical Sciences, Tehran, Iran ; Department of Emergency Medicine, Firouzgar Hospital, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran.
authors.forename: Hasan
authors.initials: H
authors.lastname: Amiri
authors.affiliation: Toxicological Research Center, Department of Clinical Toxicology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran ; Excellence Center of Clinical Toxicology, Shahid Beheshti University of Medical Sciences, Iranian Ministry of Health, Tehran, Iran.
authors.forename: Hossein
authors.initials: H
authors.lastname: Hassanian-Moghaddam
authors.affiliation: Emergency Medicine Management Research Center, Iran University of Medical Sciences, Tehran, Iran ; Department of Emergency Medicine, Firouzgar Hospital, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran.
authors.forename: Mahdi
authors.initials: M
authors.lastname: Rezai
authors.affiliation: Department of Emergency Medicine, Firouzgar Hospital, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran.
authors.forename: Zohreh
authors.initials: Z
authors.lastname: Vasei
authors.affiliation: Department of Internal Medicine, Hematology, and Oncology, Alborz University of Medical Sciences, Karaj, Iran.
authors.forename: Nillofar
authors.initials: N
authors.lastname: Ghodrati
authors.affiliation: Toxicological Research Center, Department of Clinical Toxicology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran ; Excellence Center of Clinical Toxicology, Shahid Beheshti University of Medical Sciences, Iranian Ministry of Health, Tehran, Iran.
authors.forename: Nasim
authors.initials: N
authors.lastname: Zamani
keywords: Anticonvulsants; antiepileptic drugs; overdose; poisoning; suicide; valproic acid