Severe Peripheral Oedema Associated with Valproic Acid

Abstract

Severe peripheral oedema may occur as a result of volume overload, hypoalbuminaemia, venous or lymphatic obstruction, congestive heart failure, cirrhosis and nephrotic syndrome. Avid salt retention by the renal tubules, triggered by medication, can also cause severe volume overload and peripheral oedema. Medications known to cause salt retention and oedema formation include exogenous estrogens, probably by hormonalmediation of salt retention, calcium channel blockers and arterial vasodilators, such as minoxidil and hydralazine, probably by renal tubular reaction to altered renal or glomerular haemodynamics. Isolated hormonal activation of tubular sodium retention usually does not occur, as can be observed in patients with primary hyperaldosteronism who do not develop significant oedema. In these cases, the mechanism of spontaneous resolution of the oedema occurs via the aldosterone-escape phenomenon, secretion of atrial natriuretic factor and increased glomerular filtration rate (GFR)[1,2]. We report a case of salt retention and peripheral oedema associated with valproate prescribed as treatment for bipolar disorder.