Step II Valproic acid intoxication

[yalemd]

does it cause respiratory or metabolic acidosis, and why?
thanks

 

[kryptik]

from emedicine

"Mild symptoms may occur when levels are in the therapeutic range (see above). Serious intoxication is likely at levels greater than 450 mg/L. Patients with levels greater than 850 mg/L uniformly present with coma, and 63% of them require intubation. Hemodynamic instability and metabolic acidosis may occur at levels greater than 850-1000 mg/L. Because of prolongation of half-life in overdose, a level greater than 1000 mg/L may not drop into the therapeutic range for over 3 days."

full article http://emedicine.medscape.com/article/819315-overview

 

[yalemd]

from emedicine

"Mild symptoms may occur when levels are in the therapeutic range (see above). Serious intoxication is likely at levels greater than 450 mg/L. Patients with levels greater than 850 mg/L uniformly present with coma, and 63% of them require intubation. Hemodynamic instability and metabolic acidosis may occur at levels greater than 850-1000 mg/L. Because of prolongation of half-life in overdose, a level greater than 1000 mg/L may not drop into the therapeutic range for over 3 days."

full article http://emedicine.medscape.com/article/819315-overview

Thanks for the reply. I thought it casues repi. acidosis based on the fact it supresses the respiration that accumulates CO2. Could you please tell me why it leads to metab.acidosis . I read the article and they didn't explain. thanks

 

[Golding]

Consider the name of the drug you're talking about. Valproic Acid is an acid, itself. I believe it actually causes a mixed acidosis, both respiratory and metabolic.

 

[braluk]

I think at higher levels it also causes sedation aka mild respiratory depression leading to respiratory acidosis. Seems like a mixed picture

 

[kryptik]

from the emedicine article it also causes vomiting, which can lead to metabolic alkalosis, so its mixed just like the above poster said

 

[yalemd]

Thank you all for the reply.
I know it's acidosis, the question is why metab. or respi.?
In fact, I got that question from (Fischer's Qbank) that includes both repiratory and metabolic acidosis, but in separate 2 options. There is no one option says both (Resp and Metabolic). I'd choose metabolic (as mentioned in the answer key) unless it is sever intoxication, then it is mixed. Who agrees?

 

[kemper6036]

if i remember correctly from this ER lecture this morning, it is an anion gap metabolic acidosis......not covered by our MUDPILES acronym 😡