Neurointensive care management of raised intracranial pressure caused by severe valproic acid intoxication
Marklund, Niklas LU
; Enblad, Per
and Ronne-Engström, Elisabeth
(2007)
In Neurocritical Care
7(2).
p.4-160
- Abstract
INTRODUCTION: We describe the neurointensive care (NIC) management of a patient with severe cerebral swelling and raised intracranial pressure (ICP) after severe sodium valproic acid (VPA) intoxication. A previously healthy 25-year old male with mild tonic-clonic epilepsy was found unconscious with serum VPA levels >10,000 micromol/l. The patient deteriorated to Glasgow Motor Scale score (GMS) 2 and a CT scan showed signs of raised ICP. Early ICP was elevated, >50 mm Hg, and continuous EEG monitoring showed isoelectric readings.
METHODS: The patient was treated with an ICP-guided protocol including mild hyperventilation, normovolemia, head elevation and intermittent doses of mannitol. Due to refractory elevations of ICP,... (More)
INTRODUCTION: We describe the neurointensive care (NIC) management of a patient with severe cerebral swelling and raised intracranial pressure (ICP) after severe sodium valproic acid (VPA) intoxication. A previously healthy 25-year old male with mild tonic-clonic epilepsy was found unconscious with serum VPA levels >10,000 micromol/l. The patient deteriorated to Glasgow Motor Scale score (GMS) 2 and a CT scan showed signs of raised ICP. Early ICP was elevated, >50 mm Hg, and continuous EEG monitoring showed isoelectric readings.
METHODS: The patient was treated with an ICP-guided protocol including mild hyperventilation, normovolemia, head elevation and intermittent doses of mannitol. Due to refractory elevations of ICP, high-dose pentobarbital infusion was initiated, and ICP gradually normalised.
RESULTS: There were several systemic complications including coagulopathy, hypocalcemia and pancreatitis. The patient remained in a depressed level of consciousness for 2 months but gradually recovered, showing a good recovery with minor subjective cognitive deficits by 6 months.
CONCLUSION: We conclude that NIC may be an important treatment option in cases of severe intoxication causing cerebral swelling.
(Less)
- author
- Marklund, Niklas
LU
; Enblad, Per
and Ronne-Engström, Elisabeth
- publishing date
- 2007
- type
- Contribution to journal
- publication status
- published
- keywords
- Adult, Anticonvulsants, Brain Edema, Critical Care, Epilepsy, Tonic-Clonic, Humans, Intracranial Hypertension, Male, Monitoring, Physiologic, Severity of Illness Index, Tomography, X-Ray Computed, Valproic Acid, Case Reports
- in
- Neurocritical Care
- volume
- 7
- issue
- 2
- pages
- 4 - 160
- publisher
- Humana Press
- external identifiers
-
- scopus:36949005414
- pmid:17522786
- ISSN
- 1541-6933
- DOI
- 10.1007/s12028-007-0060-6
- language
- English
- LU publication?
- no
- id
- f9bda666-6fc7-4767-9a69-fdf55d1f05de
- date added to LUP
- 2018-03-03 14:40:15
- date last changed
- 2024-01-14 15:59:45
@article{f9bda666-6fc7-4767-9a69-fdf55d1f05de,
abstract = {{<p>INTRODUCTION: We describe the neurointensive care (NIC) management of a patient with severe cerebral swelling and raised intracranial pressure (ICP) after severe sodium valproic acid (VPA) intoxication. A previously healthy 25-year old male with mild tonic-clonic epilepsy was found unconscious with serum VPA levels >10,000 micromol/l. The patient deteriorated to Glasgow Motor Scale score (GMS) 2 and a CT scan showed signs of raised ICP. Early ICP was elevated, >50 mm Hg, and continuous EEG monitoring showed isoelectric readings.</p><p>METHODS: The patient was treated with an ICP-guided protocol including mild hyperventilation, normovolemia, head elevation and intermittent doses of mannitol. Due to refractory elevations of ICP, high-dose pentobarbital infusion was initiated, and ICP gradually normalised.</p><p>RESULTS: There were several systemic complications including coagulopathy, hypocalcemia and pancreatitis. The patient remained in a depressed level of consciousness for 2 months but gradually recovered, showing a good recovery with minor subjective cognitive deficits by 6 months.</p><p>CONCLUSION: We conclude that NIC may be an important treatment option in cases of severe intoxication causing cerebral swelling.</p>}},
author = {{Marklund, Niklas and Enblad, Per and Ronne-Engström, Elisabeth}},
issn = {{1541-6933}},
keywords = {{Adult; Anticonvulsants; Brain Edema; Critical Care; Epilepsy, Tonic-Clonic; Humans; Intracranial Hypertension; Male; Monitoring, Physiologic; Severity of Illness Index; Tomography, X-Ray Computed; Valproic Acid; Case Reports}},
language = {{eng}},
number = {{2}},
pages = {{4--160}},
publisher = {{Humana Press}},
series = {{Neurocritical Care}},
title = {{Neurointensive care management of raised intracranial pressure caused by severe valproic acid intoxication}},
url = {{http://dx.doi.org/10.1007/s12028-007-0060-6}},
doi = {{10.1007/s12028-007-0060-6}},
volume = {{7}},
year = {{2007}},
}