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Prescribed Valproic Acid Syrup For Seizures. Has Gagging After A Diluted Dosage. Gravol Has No Effect. Why?

Posted on Sun, 24 Jun 2012

Question: Hello, my mother was prescribed Valproic acid syrup for seizures, 5cc per day. She often gags or almost chokes on it, unless I dilute it. She did so yesterday, and since then, she had had intermittent gagging all day long. She is able to swallow, eat and drink as normal, and apetite is unaffected, but the reflex is still happening every five minutes or so. It only subsides if she lies on her side or when she dozes, but when she wakes up, it comes back. I tried Gravol but it doesn`t seem to have any effect. It resembles the situation of someone who can`t stop hiccuping - not life-threatening, but debilitating. What can I do to stop the gagging? (Very reluctant to take her to the emergency room for this, as wait times here are no less than twelve hours, during which no food or drink allowed, and as a result, she has always gotten sick just waiting in the hospital).Thank you, T.

Answered by Dr. Rakesh Madhyastha (41 minutes later)

Hello,

Thanks for the query.

You are telling me that she is continuously having hiccups since yesterday and she not able to swallow.

I need a little more information on this, Please answer the following:

1. Is she less conscious than usual since yesterday?

2. If she is not able to even drink syrup how are you feeding her food? Is there a ryle’s tube?

3. Is she having any trouble breathing?

Gagging or difficulty in swallowing indicates weakness of one of her nerves to be more specific recurrent laryngeal nerve. Please do not force feed her if she is gagging as the food might enter into the lungs and cause pneumonia and serious complications like choking and death.
I strongly recommend you to take her to the ER (Emergency Room) for evaluation since she is on medications which should not be stopped she may require a ryle’s tube to be placed for nutrition as well as medications.

Please get back to me with the answers so that I can suggest better.

Oral medications like syrup xylocaine viscus are usually given to stop hiccups but in your mom's case since she is gagging it is contraindicated.

I wish your mother a speedy recovery.

Regards

Above answer was peer-reviewed by : Dr. Shanthi.E

Follow up: Dr. Rakesh Madhyastha (49 minutes later)

Hello, actually I said that she IS able to swallow (eating and drinking as normal). She is not less conscious and is not having any trouble breathing. I have noticed that after each gag reflex, it seems that she is trying to clear her throat, even through there is no phlegm. Due to the dementia, she tends to keep her head down, so she was cleared by a speech pathologist and ENT for feeding in an inclined position (with liquid through a syringe). As a result, though, she often gets acid reflux, which makes her throat sore.

Answered by Dr. Rakesh Madhyastha (5 hours later)

Hello,

Thanks for replying.

From what I understand, it seems your mother is been having 'gag like reflex' intermittently since yesterday. There is no choking/swallowing difficulty or breathing difficulty.

Based on your description, I think your mom might be suffering from gastritis and is causing her to have frequent eructations. Or sometimes act of choking may cause some inflammatory changes behind the throat. This may cause irritative symptoms and your mother might be trying to clear the throat.

Both the conditions are not serious concerns and they should improve in a few days. You may try some over the counter proton pump inhibitors (antiulcer medications) like prilosec or Tablet Esomeprazole 40 mg (which is prescription based drug) before her food now for 15 days every morning, along with this syp xylocaine viscus. It will help in reducing her symptoms.

If the problem persists, then please visit your primary physician for evaluation.

Feeding her in an inclined sitting position is a good habit. Please continue doing so.

I hope I have answered your query, if there are no further queries please accept my answer

Regards

Above answer was peer-reviewed by : Dr. Prasad