Clinical presentation

Effects of sodium valproate poisoning include:

• gastrointestinal effects—nausea, vomiting, abdominal pain, hepatotoxicity
• CNS effects
  • dose-dependent CNS depression (altered conscious state ranging from drowsiness to coma)
  • ataxia, cerebral oedema, seizures, respiratory depression
• cardiovascular effects—QT-interval prolongation with large ingestions (torsades de pointes not reported), hypotension, tachycardia
• metabolic effects
  • hypoglycaemia
  • large ingestions—hypernatraemia (secondary to sodium load in sodium valproate), hypocalcaemia
  • in severe toxicity—metabolic acidosis, raised blood lactate concentration, hyperammonaemia
• haematological effects—bone marrow suppression in severe toxicity causing mild to moderate thrombocytopenia and neutropenia.