Chronic valproic acid intoxication: reversal by naloxone

A 76-year-old woman being treated with sodium valproate for bipolar depression presented with a 4 day history of acute confusion and tremulousness. She had apnoeic episodes, reduced conscious level and generalised myoclonic movements. Her plasma valproate concentration was 848 mu mol/l ( normal 300-600 mu mol/l). Administration of naloxone 0.8 mg led to rapid clinical improvement. Naloxone may be useful in reversing the features of chronic valproate toxicity.