Level
Does not correlate well with toxicity (can be therapeutic with toxicity)
Adverse effects increase with level >150
Chemistry
Hypocalcemia, hypernatremia, hypophosphatemia, AG metabolic<unk> osis
LFTs
Elevated transaminases
Hyperammonemia
Can be asymptomatic or cause Valproate associated Hepatic Encephalopathy (VPE)
Secondary to L-Carnitine and Acetyl-CoA depletion which inhibits urea cycle
Can be seen with therapeutic VPA levels and normal LFTs
Level does not correlate with severity of VPE
Does not correlate well with toxicity (can be therapeutic with toxicity)
Adverse effects increase with level >150
Hypocalcemia, hypernatremia, hypophosphatemia, AG metabolic<unk> osis
Elevated transaminases
Can be asymptomatic or cause Valproate associated Hepatic Encephalopathy (VPE)
Secondary to L-Carnitine and Acetyl-CoA depletion which inhibits urea cycle
Can be seen with therapeutic VPA levels and normal LFTs
Level does not correlate with severity of VPE
Valproic acid toxicity
Tianeptine toxicity
Carbamate toxicity
Lithium toxicity
Benzodiazepine toxicity
Phenytoin toxicity
Antipsychotic toxicity
Carbamazepine toxicity