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This case of severe acute VPA toxicity highlights a number of biochemical and metabolic features associated with VPA overdose, including hyperammonemic encephalopathy with profound respiratory alkalosis, an increased AG metabolic acidosis, hypernatremia, hypocalcemia, and thrombocytopenia (1).
Vasospasm was not observed with hyperventilation-induced respiratory alkalosis or the cold pressor test.
In short, he produced a metabolic state called respiratory alkalosis, caused by a reduction in blood carbon dioxide levels.
Despite supportive treatment (including administration of plasma from a BHF survivor), his condition worsened; hematemesis, melena, hematochezia, hematuria, anuria, respiratory alkalosis, and metabolic acidosis developed in the patient, eventually resulting in death.
The only initial area of concern was that tonic-clonic movements were observed in a few patients in association with respiratory alkalosis and deep anaesthesia.
14) The HVR increases the respiratory rate, leading to a respiratory alkalosis and an increased arterial oxygen saturation.
25) After about 30 minutes of hyperventilation, however, there is a drop in potassium, with a shift of potassium from the intracellular to extracellular space as the body attempts to buffer the respiratory alkalosis with K+ ions replacing H+ ions.