Hemodialysis and hemoperfusion for treatment of valproic acid and gabapentin poisoning.
A 31-y-old epileptic man developed coma and shock after suicidally ingesting large amounts of valproic acid and gabapentin. His peak valproic acid, level was 1306.9 micrograms/mL (therapeutic range = 30-100 micrograms/mL). His peak gabapentin level was 60.0 micrograms/mL (therapeutic range = 2.0-8.0 micrograms/mL). His hypotension was refractory to crystalloid and pressor infusions, but resolved during concurrent hemoperfusion and hemodialysis to enhance elimination of valproic acid. Concurrent hemoperfusion and hemodialysis, in series, produced a maximum valproic acid plasma clearance of 55.4 mL/min versus a maximum reported intrinsic valproic acid plasma clearance of 10.6 mL/min. 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.
Fernandez
M C
MC
Department of Surgery and Arizona Poison and Drug Information Center, USA.
Walter
F G
FG
Kloster
J C
JC
Do
S M
SM
Brady
L A
LA
Villarin
A
A
Ruffenach
S J
SJ
Prosnitz
E H
EH
Salmon
J V
JV
D000085:Acetates / Q000506:poisoning*; D000328:Adult; D000588:Amines; D000927:Anticonvulsants / Q000008:administration & dosage / Q000506:poisoning*; D015415:Biomarkers / Q000097:blood / Q000652:urine; D001774:Blood Chemical Analysis; D002855:Chromatography, Thin Layer; D003128:Coma / Q000139:chemically induced / Q000628:therapy; D003509:Cyclohexanecarboxylic Acids; D018682:GABA Agents / Q000008:administration & dosage / Q000506:poisoning*; D000077206:Gabapentin; D008401:Gas Chromatography-Mass Spectrometry; D006464:Hemoperfusion; D006801:Humans; D007022:Hypotension / Q000139:chemically induced / Q000628:therapy; D007362:Intensive Care Units; D008297:Male; D006435:Renal Dialysis; D012769:Shock / Q000139:chemically induced / Q000628:therapy; D014635:Valproic Acid / Q000506:poisoning*; D005680:gamma-Aminobutyric Acid
D000085:Acetates; D000588:Amines; D000927:Anticonvulsants; D015415:Biomarkers; D003509:Cyclohexanecarboxylic Acids; D018682:GABA Agents; D005680:gamma-Aminobutyric Acid; D014635:Valproic Acid; D000077206:Gabapentin