A Case of Delirium and Subsequent Pancytopenia Associated With the Oral Loading of Valproic Acid

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Sir: Some studies have shown that the oral loading of valproicacid or divalproex sodium is most likely safe and leads tomore rapid antimanic effects than standard titration of theseagents.^1-4 Although there are some case reports of delirium^5,6 orpancytopenia^7-12 associated with valproic acid, as far as weknow, serial acute adverse effects such as delirium and pancytopeniaresulting from the oral loading of valproic acid have not yet been reported. We present a case in which manic symptomswere relieved rapidly with the oral loading of valproic acid, butdelirium and subsequent pancytopenia developed as acute, severeadverse effects.’ ‹