Massive Valproic Acid Overdose With Confirmed Pharmacobezoar Formation and Neuromuscular Toxicity: A Case Report and Literature Review

We present a 42-year-old man who arrived obtunded to our emergency department (ED) after ingesting 60 g of extended-release valproic acid (VPA). Imaging and endoscopy confirmed a pharmacobezoar, a rare complication of overdose.The patient was managed with early airway protection, gastrointestinal (GI) decontamination, intravenous (IV) levocarnitine (L-carnitine), naloxone, and continuous renal replacement therapy (CRRT). His initial hospital course was stable but later complicated by delayed neuromuscular toxicity with extrapyramidal symptoms (EPS) requiring inpatient rehabilitation and multidisciplinary follow-up. This case highlights the clinical challenge of massive VPA overdose complicated by pharmacobezoar formation and delayed neuromuscular sequelae. Early risk assessment led to recognition and aggressive treatment of a potentially life-threatening ingestion in which airway protection, serial monitoring, endoscopic confirmation, and extracorporeal elimination were crucial to a favorable outcome. This case underscores the need for vigilance in severe VPA ingestions and reinforces the role of advanced diagnostic and therapeutic strategies in preventing further deterioration.