Patients with Valproic acid (VPA) toxicity develop all of the following EXCEPT? (select one) A) hyponatremia B) hyperosmolality C) hypocalcemia D) anion gap acidosis E) elevated osmolal gap Answer: A Knowing how Cardio Bites for Dogs Zesty Paws Valproic Acid Toxicity When the calmer becomes the culprit In the ICU, some tox cases whisper and some unravel like a metabolic domino cascade. Valproate toxicity belongs to the latter. A 33 Year Old Woman With Altered Mental Status and Elevated Ammonia Level CHEST