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11 Cards in this Set
- Front
- Back
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Detail the 'RRS' in "RRSIDEAD" Approach to
valproate overdose |
Resuscitation : CNS and CVS depression
Risk assessment : > 400mg/kg = Likely CNS depression and intubation intubation |
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Detail the 'I' in "RRSIDEAD" approach to
valproate overdose |
Investigations
General : BSL / ECG and bHcg Specific: 1. Serial valproate levels Haemodialysis if: serum level > 7000 umol/L Level > 10,400 umol/L AT ANY STAGE 2. HAGMA - lactate 3. Ammonia - elevated |
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Detail the 'DE' in "RRSIDEAD" approach to
valproate overdose |
Decontamination
- Activated charcoal (AC) in > 400 mg/kg ingestion - Repeat dose AC at 3-4 hours if bowel sounds and rising valproate levels |
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Detail the 'AD' in "RRSIDEAD" approach to
valproate overdose. |
Antidote: none
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Tintinalli Which of the following Valproate CNS actions is incorrect ? A. Increases GABA B. Increases G-Hydroxybutyrate C. Blocks NMDA receptors D. Prolongs recovery of inactivated Sodium channels |
B. Decreases release of Gamma Hydroxybutyrate |
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Tintinalli Which is incorrect regarding the clinical features of Acute valproate toxicity? A. The most frequent sign is CNS depression B. Respiratory depression is a feature. C. Hypotension can occur. D. A NAGMA is a feature. |
D. HAGMA |
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Tintinalli Which of the following metabolic / biochemical effect do not occur with acute valproate toxicity? A. Hyperglycaemia B. Hypernatraemia C. Hypocalcaemia D. Hyperammonaemia. |
A. Hypoglycaemia occurs with Valproate toxicity. |
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Tintinalli Which of the following biochemical/ metabolic effects does not occur with acute valproate toxicity? A. Aminotransferase liver enzyme elevations. B. Elevated lactate C. HAGMA D. Hyperphosphataemia |
D. Valproate Toxicity = Hypophosphataemia |
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Tintinalli Which of the following does not occur with Acute valproate toxicity ? A. Thrombocytopenia B. Pancreatitis C. Hyponatraemia D. HAGMA |
C. Hypernatraemia occurs with Valproate Toxicity |
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Tintinalli What are the management options for Acute valproate overdose ? |
1. MDAC ( enteric coated ) - initial dose + repeat dose at 3-4 hours if : a. levels rising b. Bowel sounds present 2. WBI (controversial ) - ingestion > 1G/kg presenting < 4 hours 3. Haemodialysis / Haemofiltration 4. L-Carnitine ** |
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What are the indications for Haemodialysis in acute valproate overdose ? |
1. Ingestion > 1G/kg 2. Cardiovascular instability 3. Lactic acidosis 4. Levels - > 7000 umol/L - Level > 10,400 mol/L at any stage |
