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The Annals of Pharmacotherapy: Vol. 37, No. 12, pp. 1797-1799. DOI 10.1345/aph.1D122
© 2003 Harvey Whitney Books Company.
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Intravenous Valproate Associated with Circulatory Collapse

Prashant Kumar, MRCPCH

Specialist Registrar in Paediatrics, Department of Paediatrics, Royal Victoria Infirmary, Newcastle upon Tyne, England

Christopher J Vallis, FRCA

Consultant Anaesthetist, Paediatric Intensive Care Unit, Royal Victoria Infirmary

Catherine M Hall, MR PharmS BSc

Pharmacist, Pharmacy Department, Royal Victoria Infirmary

Reprints: Prashant Kumar MRCPCH, Department of Paediatrics, Royal Victoria Infirmary, Queen Victoria Rd., Newcastle upon Tyne, NE1 4LP, England, FAX 0191 2840001, prashant65{at}yahoo.com

OBJECTIVE: To report a case of severe circulatory collapse following an intravenous injection of sodium valproate.

CASE SUMMARY: A 5-year-old white girl, who was receiving vasopressor support, developed a severe circulatory collapse following an intravenous injection of valproate 480 mg. Her invasive arterial blood pressure dropped after valproate was started, and she went into cardiac arrest requiring full resuscitation including 2 doses of epinephrine. She was successfully resuscitated.

DISCUSSION: To the best of our knowledge, this is the first case report of such severe circulatory collapse associated with intravenous valproate. Although hypotension has been reported following the use of intravenous valproate, severe circulatory compromise leading to cardiorespiratory arrest has not been previously described. An objective causality assessment using the Naranjo probability scale revealed that the adverse drug event was highly possible.

CONCLUSIONS: In view of this patient's circulatory collapse associated with valproate, intravenous sodium valproate should be used with caution, particularly in hemodynamically unstable patients.

Key Words: hypotension, intravenous valproate

Published Online, October 29, 2003. www.theannals.com, DOI 10.1345/aph.1D122




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Copyright © 2003 by Harvey Whitney Books Company.