Korean J Med.  2004 Oct;67(4):404-408.

A life-threatening case of acute valproic acid overdose treated successfully with serial hemoperfusion and hemodialysis

• Park JH
• Park JS
• Park MY
• Joo HS
• Yang JO
• Lee EY
• Hong SY

Abstract

Valproic acid is available as an antiepileptic therapy and has been used treat bipolar disorder and migraine headaches. In the setting of accidental or intentional ingestion of valproic acid overdose, serious toxicitis have been reported including leukopenia, thrombocytopenia, hemodynamic compromise, respiratory failure, cerebral edema, renal failure, hepatotoxicitiy, and coma. The optimal therapy for life-threatening case of acute valproic acid overdose has not been clearly established. A 34-year-old man developed coma and shock after suicidally ingesting large amount of valproic acid (45,000 mg). The peak serum valproic acid concentration on admission was 1400 micro gram/mL (therapeutic range 50~100 micro gram/mL). His hypotension was refractory to crystalloid and pressor infusions, but resolved during concurrent hemoperfusion and hemodialysis to enhance elimination of valproic acid. After serial hemoperfusion and hemodialysis, serum valproic acid level decreased to 680 micro gram/mL, coincident with improvement in clinical status. Concurrent hemoperfusion and hemodialysis, in series, should be considered in hemodynamically unstable patients with valproic acid poisoning whose clinical condition is worsening in spite of aggressive supportive care.

Keyword

Valproic acid; Hemoperfusion; Hemodialysis

MeSH Terms

Adult
Bipolar Disorder
Brain Edema
Coma
Eating
Hemodynamics
Hemoperfusion*
Humans
Hypotension
Leukopenia
Migraine Disorders
Poisoning
Renal Dialysis*
Renal Insufficiency
Respiratory Insufficiency
Shock
Thrombocytopenia
Valproic Acid*
Valproic Acid