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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by Joan on September 6, 1999, at 7:22:52
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.
Posted by James Justice on September 6, 1999, at 17:40:03
In reply to 209 Depakote level, posted by Joan on September 6, 1999, at 7:22:52
> 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
Posted by Joan on September 7, 1999, at 13:10:44
In reply to Re: 209 Depakote level, posted by James Justice on September 6, 1999, at 17:40:03
> > 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.
>
> JamesThanks 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.
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
Posted by Joan on September 8, 1999, at 21:05:27
In reply to Re: 209 Depakote level, posted by Carmen on September 8, 1999, at 14:13:11
> > > > 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 - CarmenCarmen,
I've gathered a lot of information, but not what I really need and have asked for repeatedly from numerous sources. I've taken to tracking down clinical trials and journal articles through NIH pub. services. In the absence of "lay-it-on-the-line" medical opinion anyone is willing to stick their neck out and share, I've discovered that the 125 upper end of therapeutic range reported in clinical trials was a trough, suggesting what peak? (obtained at risk of subjects in trial) It's my contention that a 209 level wasn't life threatening or suggestive of any attempt at suicide. Rather, in the literature, you read of people who overdosed deliberately, had levels of 10 times the therapeutic max and more -- and recovered. It's one thing to have an elevated level -- another for any overbearing Nurse Ratchet type to disregard what you tell her about how, when, and why you took what dosage of the drug, strap you down and shove tubes up your nose, against your will, then expect you to pay an arm and a leg for that experience. James Justice said, if I understood him correctly, that activated charcoal would be done if a person had just ingested a large quantity of the drug, which was not the case. Obviously, I'm still angry about it. In all, I only tried Depakote over a two-week period, not for acute mania either, but supposedly as a prophylactic measure. Though I was orginally diagnosed bipolar in about 1974, for last twenty years have successfully avoided all but one brief hospitalization -- have been able to interupt manic progression with combination of trilafon, cogentin and dalmane or, later, restoril as a sleep aid. Never stayed on lithium for any prolonged period of time. Guess I don't have such a bad case of this, but have also prided myself on managing my illness well. In this case, the "cure" was worse than the illness -- that's for sure. Still wish someone with strong medical background would address the issue honestly -- no way I believe 209 was life threatening. What I think happened is that er personnel treated me "like a crazy person," another psychiatric label, disregarded my self-report, and half-acted "punitively" as I was being "uncooperative". If I'm all wrong about this, I sure wish someone would set me straight. It would be easier to respect people in the medical profession if they didn't close ranks and try to cover each others' actions -- good, bad, and otherwise. I'm generally disgusted at what it takes to get info. when you no longer have an MD in the family -- other MDs seem afraid to say much one way or another. Oh, interesting journal article from a Richard Brown at Columbia tells how hospitalized Medicaid patients in some area of Pennsylvania don't get their Depakote levels taken even once in a year!!! -- now that's because . . . go ahead, your gue$$ is probably as good as mine, when it comes to the quality of anyone's medical care.
Posted by georgia on May 21, 2000, at 22:05:00
In reply to Re: 209 Depakote level, posted by Joan on September 8, 1999, at 21:05:27
My grandmother is currently on depakote, zyprexa & cogentin. Can anyone tell me how often she should have her depakote level checked?? It seems she is lucky if she has it checked once a year. She was diagnosed bipolar a number of years ago. Initial treatment was with lithium, to which she had a reaction after a number of years on this medication. I am concerned the same thing is happening with the Depakote. She is hardly able to walk, and shakes uncontrollably. I have talked w/ her Dr. but the Dr. doesn't seem concerned. Thanks for any insight.
Georgia
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