Intensive care unit (ICU) delirium is characterized by acute onset of cerebral dysfunction with a change or fluctuation in baseline mental status. Delirium management includes non-pharmacologic and pharmacologic treatment. However at times, alternative pharmacologic treatment is warranted. Valproic acid (VPA) is a potential pharmacologic agent that can be utilized to treat ICU delirium, though there is a paucity of evidence for its use, especially in patients with a history of substance abuse. We review the literature on VPA use in ICU delirium, and describe a challenging case of a 27-year-old female with a history of substance abuse experiencing hyperactive ICU delirium for greater than a month, refractory to multiple treatment modalities, and successfully treated with VPA therapy.
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