Should Pharmacies Be Included in Medication Reconciliation? A Report of Recurrent Valproic Acid Toxicity
- Resource Type
- Authors
- L. Jeff Harris; Shanise Patterson; Jessica V. Rivera; Megan A. Van Berkel; Samarth P. Shah; B Tate Cutshall
- Source
- Clinical Practice and Cases in Emergency Medicine, Vol 1, Iss 2 (2017)
Cutshall, B. Tate; Shah, Samarth P.; Van Berkel, Megan A.; Patterson, Shanise; Harris, L. Jeff; & Rivera, Jessica V.(2017). Should Pharmacies Be Included in Medication Reconciliation? A Report of Recurrent Valproic Acid Toxicity. Clinical Practice and Cases in Emergency Medicine, 1(2). doi: 10.5811/cpcem.2016.12.33002. Retrieved from: http://www.escholarship.org/uc/item/4z99356h
Clinical Practice and Cases in Emergency Medicine
- Subject
- medicine.medical_specialty
Case Report
Pharmacy
Emergency Nursing
030226 pharmacology & pharmacy
Cerebral edema
03 medical and health sciences
Patient safety
0302 clinical medicine
medicine
Divalproex Sodium
Hospital discharge
030212 general & internal medicine
Intensive care medicine
Valproic Acid
business.industry
lcsh:Medical emergencies. Critical care. Intensive care. First aid
lcsh:RC86-88.9
medicine.disease
Medication Reconciliation
Toxicity
Emergency medicine
Emergency Medicine
lipids (amino acids, peptides, and proteins)
business
medicine.drug
- Language
- ISSN
- 2474-252X
Including outpatient pharmacies in the medication reconciliation process upon hospital discharge is not commonly performed. This case highlights the consequences of a patient refilling a discontinued prescription for valproic acid (VPA). We present a 32-year old male found unresponsive after ingesting delayed release divalproex sodium. Cerebral edema was visualized on magnetic resonance imaging. Hemodialysis and levo-carnitine treatment led to improved mental status, and VPA was discontinued. The same patient presented with VPA overdose eight months later after he continued to fill an outdated prescription. This case highlights consequences of VPA toxicity; it also demonstrates an opportunity to improve patient safety and high-value care by collaborating with outpatient pharmacies in the medication reconciliation process upon hospital discharge.