Posted by Carmen on September 8, 1999, at 14:13:11
In reply to Re: 209 Depakote level, posted by Joan on September 7, 1999, at 13:10:44
> > > Last spring I tried Depakote for moderation of bipolar disorder. No other medications. Apparently, I overdosed on the stuff -- experienced "drunken" like effects -- slurred speech, disrupted balance, police suspected I was inebriated, paramedics tooks me to an emergency room, where I was subjected to charcoal flushing. Was this necessary? Lab showed 209 Depakotre level? What danger was I in? Was some other nonemergency response more appropriate/ less costly? Did I have any right to refuse such medical intervention? Would appreciate any leads.
> >
> > First of all, I can tell you that the therapeutic plasma level of Depakote should be in the range of 50 to 100 micrograms/mL. 209 sounds toxic, and it is easy to see why you experienced those symptoms.
> > As far as how you were treated at the hospital, the charcoal treatment would only be helpful if you had recently ingested an overdose of Depakote, not if you were just at a toxic blood level. Emergency rooms usually do administer charcoal "just in case", and it is not harmful, but a bit expensive. Since you had accumulated that Depakote level over time, there is little that can be done in an ER. They could try hemodialysis or tandem hemodialysis in the hope that not too much of the drug is protein-bound already. Naloxone could be used to reduce some of the bad side effects, but it must be used carefully as it could cause a Depakote withdrawal seizure. Overall, this was a tricky situation.
> >
> > I am glad to hear that you are OK. Be very careful if you continue on Depakote and get blood levels at least weekly from now on.
> >
> > James
>
> Thanks for your response. I must seem an ingrate, but the charcoal treatment was not only expensive -- exorbitantly so, in my opinion, but excruciating. I read somewhere -- possibly in literature from Abbott Labs. -- that people have recovered from overdosage where valprocic acid was at 2,120 level. This caused me to wonder at what point is a level over 125 (max stated for clinical trials) life-threatening? I did try to refuse treatment -- ER wasn't having any of that since I'd been brought there by paramedics at polic order, but I didn't perceive that I was in an "emergency" situation. Other than "symptoms" described was alert, tried to make it clear that I hadn't attempted suicide, etc. Assuming you are an MD, would you have seen this as a situation requiring intensive care? Bills for a hospital stay of about 24-hour are about $5,000. Seems to me that doctors and med. facilities are increasingly inclined to go for the overkill, fearing malpractice. What I'm looking for in way of answer is what would have been reasonable response - on a scale of 1 to 10 where 10 is major life-threatening situation, where would 209 Depakote in a person with no history of respiratory or heart problems fall? I am going to call Abbott Labs and see if anyone there can address these questions -- if anyone else is interested.Joan, Hi What an experience! James is right about the levels. Do you have regular blood tests done to see where your level is at? Are you following your Dr.'s prescribed dosage? I know that this is all very important as the liver (I believe) metabolizes this drug. Be careful! Stay healthy - Carmen
poster:Carmen
thread:11099
URL: http://www.dr-bob.org/babble/19990829/msgs/11252.html