Sodium Valproate Toxicity in Emergency Department Patients: A Retrospective Study from a Tertiary Academic Hospital

Background: Sodium valproate (SV) overdose primarily causes central nervous system depression and metabolic disturbances. The objective of this study was to describe the clinical characteristics and outcomes of patients presenting with SV toxicity to the emergency department (ED). Methodology: This retrospective cohort study was conducted in the ED (2012–2021), included patients with SV levels above the therapeutic range (>693 μmol/L). Acute toxicity cases involved ingestion within 24 h, whereas chronic toxicity cases had prolonged SV use with toxicity symptoms from accumulated levels. Results: Of 4034 serum SV levels reviewed, 368 (9.12%) exceeded the therapeutic range; 87 cases met the inclusion criteria. Males comprised 64.4% (56/87), and the mean age was 18.76 (standard deviation: 15.65) years. Chronic toxicity accounted for 96.5% (84/87) and acute toxicity for 3.5% (3/87). Median valproate levels were 2243.0 (interquartile range [IQR] 1179.0) μmol/L in acute and 764.5 (IQR 95.5) μmol/L in chronic cases. Neurological symptoms dominated, with seizures in 78.6% (66/84) of chronic and 33.3% (1/3) of acute cases. Gastrointestinal symptoms occurred in 28.6% (24/84) of chronic and 66.7% (2/3) of acute cases. Lab findings showed abnormal platelets (14.3%, 12/84), white blood cell counts (19.1%, 16/84), Renal Function Test (RFT) (58.6% [51/87]), and Liver Function Test (LFT) (18.3% [16/87]) abnormalities in the chronic group. Noninvasive ventilation was needed in 21.4% (18/84) of chronic cases. One patient (acute) received activated charcoal. Most (54.0%, 47/87) were discharged from the ED, whereas 46.0% (40/87) required admission. Conclusions: Chronic toxicity was more prevalent, with seizures as the most common neurological symptom. Nearly half of the patients required admission, with no toxicity-related mortality.