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Abstract：
Objectives Valproic acid (VPA) is an anticonvulsant used in several clinical scenarios. VPA has been increasingly associated with intentional or unintentional overdose. In patients presenting with severe VPA overdose, supportive care and airway protection are cornerstones of treatment, while levocarnitine is suggested in patients with hyperammonemia and hemodialysis is recommended in patients with VPA serum concentrations (SC) >1,300 mg/L and presence of cerebral edema or shock. Meropenem is a carbapenem antibiotic with a broad spectrum of activity. The pharmacological interaction between VPA and meropenem is characterized by a rapid decrease in VPA concentrations, which contraindicates concurrent use. Case presentation The following case report describes the use of meropenem to enhance the clearance of VPA in the case of severe VPA overdose. A patient with altered mental status was transported to the emergency department (ED) after VPA overdose. Meropenem was prescribed for significant elevated VPA SC. An important decline in SC was observed with short-term meropenem dosing, and an improvement in mental status occurred shortly after administration. Conclusions Carbapenem therapy has the potential to be used as last line strategy in the management of severe VPA overdose in patients where SC represent a significant risk of toxicity and clinical symptoms suggest difficulty managing the patient.
摘要：
目的丙戊酸（VPA）是一种抗惊厥药，用于多种临床场合。VPA越来越多地与有意或无意的过量有关。在出现严重VPA过量的患者中，支持性护理和气道保护是治疗的基石，而高氨血症患者建议使用左卡尼汀，VPA血清浓度（SC）>1,300mg/L且存在脑水肿或休克的患者建议进行血液透析。美罗培南是一种具有广谱活性的碳青霉烯类抗生素。VPA和美罗培南之间的药理学相互作用的特征是VPA浓度迅速下降，禁止同时使用。病例介绍以下病例报告描述了在严重VPA过量的情况下使用美罗培南来增强VPA的清除。VPA过量后，精神状态改变的患者被送往急诊科（ED）。美罗培南用于显著升高的VPASC。短期美罗培南给药观察到SC的重要下降，用药后不久，精神状态有所改善。结论碳青霉烯治疗有可能作为治疗严重VPA过量患者的最后一线策略，其中SC代表明显的毒性风险，临床症状表明难以管理患者。
