Advice please!!

Specialties Geriatric


Hi Everyone!

I am a student RN and went to my 2nd clinical yesterday at my local nursing facility.

My patient had last stages of Alzheimer's, seizures, DM II, full contractures, incontinence, etc.

I am currently looking at all the info I gathered and I see that her Valproic Acid level was down quite a considerable amount during one of her recent hepatic function panel testings. She is on Depakote 250 mg bid. Will this affect her V.acid levels?? Is it due to the DM II as well?

I have searched the net and my diagnostic lab manual, but can't find any decent ground info. I would SO appreciate any help!

Thank you SO much!


88 Posts

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. ;)


88 Posts

Specializes in OB/GYN.

No to Tagamet, and her valproic acid levels were low, which is what I found to be odd, seeing as she is on Depakote. She is also taking Klonopin, OS-Cal, and Glucophage. That's why I wondered if the DM II was messing her up.

Thank you so much for answering so quick! You're a star!:kiss


1,010 Posts

Specializes in ER CCU MICU SICU LTC/SNF.

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. ;)


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.

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


88 Posts

Specializes in OB/GYN.


You are an angel. YES, I would much rather have a clue/nudge than a given answer and you have given me food for thought. I see in my PDR that, considering the severity of the patient's seizures, she is on a relatively low dose.

I had not, however, realised the problem between Klonopin and Depakote. She is very, very drowsy in the mornings and seems to be constantly "out-of-it", although her strength is never-diminishing. She's a "fighter", bless her soul.

I shall definitely mention what you said to my teacher though. I certainly don't want her to become at risk for coma.

Thanks for helping me to find the answer. You're a great teacher! I'll keep you informed!

Have a great evening!:kiss


4 Posts

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.


44 Posts

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.


88 Posts

Specializes in OB/GYN.

Hey Guys,

Yes, she IS last stages of Alzheimers and yes, she does have major behavioral behaviors. (senile depression and epilepsy plus aggression)

I have written up in my report that Depakote and Klonopin should not normally be used in conjunction with one another................ found evidence in my PDRs too.

We'll see what my instructor has to say too.

Thanks so much for all of your input. Much appreciated.



558 Posts

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

CoffeeRTC, BSN, RN

3,734 Posts

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?


1 Article; 2,334 Posts

Another consideration:

Sometimes meds have the desired thereputic effect at levels less than the established ranges, and are adjusted based on the desired outcome.

Especially in the elderly and Peds.


88 Posts

Specializes in OB/GYN.

All things for me to check out and put forward.

Thank you all so much for your input. I'll be interested to see if my instructor takes note of my concerns!

Watch this space.....................

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