Abstract
Valproic acid (VPA) toxicity is a serious and potentially life-threatening condition that can arise from overdose or impaired drug metabolism. While mild cases may present with central nervous system depression, severe toxicity can lead to coma, multi-organ failure, and death. This case report discusses a 21-year-old male with a history of schizoaffective disorder, polysubstance abuse, and suicidal ideations who presented with altered mental status after a suspected overdose of VPA. His serum valproate level was found to be 879 µg/mL, significantly exceeding the therapeutic range. Despite initial supportive care, including intravenous fluids, activated charcoal, and L-carnitine, the patient's condition failed to improve. After consultation with toxicology, neurology, and nephrology teams, the decision was made to initiate continuous renal replacement therapy (CRRT) to expedite the removal of valproate. The patient's mental status gradually improved, and he was successfully extubated after three days of hospitalization. This case highlights the importance of early recognition, aggressive management, and the potential role of hemodialysis in improving outcomes in patients with severe VPA toxicity. Timely intervention can significantly reduce mortality and morbidity associated with VPA overdose.