Extracorporeal elimination in acute valproate intoxication

Extracorporeal elimination in acute valproate intoxication

Severe poisoning with valproate may result in coma and death. The management of valproate intoxication is principally supportive. Valproate is scarcely excreted renally and is mainly protein bound and, therefore, not considered to be amenable for extracorporeal elimination. Despite these unfavourabl...

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Bibliographic Details
Published in:BMJ case reports Vol. 2009; no. jan27 1; p. bcr0620080337
Main Authors: Wouden, Els A van der, Dekkers, Angela, Kruis, Hannah M E, Geijlswijk, Ingeborg M van, Tjan, David H, Feith, Geert W
Format: Journal Article
Language:English
Published: England BMJ Publishing Group LTD 2009
BMJ Publishing Group
Series:Novel treatment (new drug/intervention; established drug/procedure in new situation)
Subjects:
Acidosis
Case reports
Charcoal
Coma
Europe (West)
Hemodialysis
Hemodynamics
Intoxication
Intubation
Male
Metabolism
Metabolites
Nervous system
Novel Treatment (New Drug/Intervention; Established Drug/Procedure in New Situation)
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Summary:Severe poisoning with valproate may result in coma and death. The management of valproate intoxication is principally supportive. Valproate is scarcely excreted renally and is mainly protein bound and, therefore, not considered to be amenable for extracorporeal elimination. Despite these unfavourable pharmacokinetic properties, several case reports showed successful treatment of valproate intoxication with haemodialysis and/or haemoperfusion. We describe a male patient (57 years) after ingestion of 64 g of valproate. The patient was successfully treated with haemodialysis for 6 h. Haemodialysis was followed by continuous venovenous haemodiafiltration (CVVH-D) for 18 h to prevent a rebound phenomenon. This report confirms the benefit of haemodialysis in serious valproate overdose. A review of the literature shows that haemodialysis followed by CVVH-D is the treatment of choice in severe valproate intoxication.
ISSN:1757-790X
1757-790X
DOI:10.1136/bcr.06.2008.0337