title: Extracorporeal management of valproic acid toxicity: a case report and review of the literature.
abstract: The incidence of intentional or accidental valproic acid (VPA) overdose is increasing. Severe VPA toxicity may lead to coma and death. Traditionally the treatment of patients with VPA toxicity has been limited to supportive measures. VPA is highly protein bound and therefore it is considered not to be removable by extracorporeal means. However, studies of VPA toxicokinetics indicate that at blood levels that exceed therapeutic concentrations, VPA protein binding sites become saturated, leading to increased concentration of the free unbound drug. The free unbound drug has a small molecular weight and therefore it is theoretically amenable to removal by extracorporeal means. We present a patient with VPA toxicity who was successfully treated with "in-series" hemodialysis and hemoperfusion followed by continuous venovenous hemodiafiltration (CVVHDF) and review the literature on the management of VPA toxicity using extracorporeal therapies.
authors.affiliation: Division of Nephrology, Saint Louis University, St. Louis, Missouri 63110, USA. zalaly@slu.edu
authors.forename: Ziyad
authors.initials: Z
authors.lastname: Al Aly
authors.forename: Praveen
authors.initials: P
authors.lastname: Yalamanchili
authors.forename: Esther
authors.initials: E
authors.lastname: Gonzalez
mesh_terms: D000328:Adult; D018692:Antimanic Agents / Q000009:adverse effects* / Q000378:metabolism; D001714:Bipolar Disorder / Q000097:blood / Q000188:drug therapy; D062787:Drug Overdose; D017583:Hemodiafiltration / Q000379:methods; D006464:Hemoperfusion; D006801:Humans; D008297:Male; D006435:Renal Dialysis / Q000379:methods; D014635:Valproic Acid / Q000009:adverse effects* / Q000378:metabolism
chemical_list: D018692:Antimanic Agents; D014635:Valproic Acid