Intravenous Valproate Associated with Circulatory Collapse

OBJECTIVE: To report a case of severe circulatory collapse following an intravenous injection of sodium valproate. CASE SUMMARY: A 5-year-old white girl, who was receiving vasopressor support, developed a severe circulatory collapse following an intravenous injection of valproate 480 mg. Her invasive arterial blood pressure dropped after valproate was started, and she went into cardiac arrest requiring full resuscitation including 2 doses of epinephrine. She was successfully resuscitated. DISCUSSION: To the best of our knowledge, this is the first case report of such severe circulatory collapse associated with intravenous valproate. Although hypotension has been reported following the use of intravenous valproate, severe circulatory compromise leading to cardiorespiratory arrest has not been previously described. An objective causality assessment using the Naranjo probability scale revealed that the adverse drug event was highly possible. CONCLUSIONS: In view of this patient's circulatory collapse associated with valproate, intravenous sodium valproate should be used with caution, particularly in hemodynamically unstable patients.