Advice please!!

Depakote is Valproic Acid. But Tagamet can alter the metabolism. Is this pt. on Tagamet? Also it can cause a false + on Ketones. In the elderly meds can have a slow metabolism so it would not be unusual to have high Valproic Acid. Hope this helps.

You seem to be a responsible student and did some research. But before I get killed by my fellow nurse and be hated by your beloved teacher, I'd rather give you a clue rather than an answer....

Here goes...

Let's not jump into the drug interactions and diagnoses just yet.

You said the Valproic acid level is low. Mazzie said Valproic acid is Depakote.

Review the drug dosage the patient is getting. Now, I want you to look at the recommended daily dose for Depakote.

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Non-related to your homework but struck my attention - the Klonopin-Depakote combination!!!

We had a patient go into coma but since she was a DNR and per family's request, no aggressive measures were done. MD gave a presumptive dx, massive CVA. All medications were withheld, incldg. Klonopin and Depakote, and was sustained only w/ just parenteral hydration. 10 days later, she woke up.

Now I stumbled into this...
Drug-to-Drug Interactions: Usage of Klonopin should be avoided while taking Depakote, as Depakote may cause the Klonopin to accumulate to high levels in the bloodstream causing sedation and even stupor.

http://www.epipro.com/drugs.html#klonopin

Is your patient awake??? Mention it to your teach anyway.

I think that I would first find out if this pt. is actually taking the medication..Depakote. Is she swallowing? Usually last stage Alzheimer's have a decreased swallowing ability. Then , if that's the case....I would consider the malabsorbtion of the medication due to the other medications, and the diabetes.

I would also like to point out that this resident may be on depakote for behavior management issues. We are using depakote and klonopin more and more for behaviors, this may explain the low dose and being used in combination...Just anopther thought.

Depakote has the rare but still valid side effect of aggression and even psychosis. I have seen this. Just a thought.

Just another idea or thought about how she is getting the drug. Is she swallowing the pill? How about the liquid are they shaking the bottle before poring?