title: Severe valproic acid intoxication is associated with atrial tachycardia: secondary detoxication by hemoperfusion.
abstract: Valproic acid is an anticonvulsant drug which is associated with serious toxicity including fatal outcome in case of severe intoxication. Secondary detoxication by hemodialysis or hemoperfusion has been employed successfully in valproic acid intoxication. Cardiac arrhythmias have only been described rarely in valproic acid intoxication in humans. We report on a 15 year-old boy with severe valproic acid intoxication (valproic acid plasma level on admission: 1 150 mg/l) who presented with coma, hypernatremia and atrial tachycardia. The patient was successfully treated with hemoperfusion and intensive supportive care without implementation of a specific antiarrhythmic therapy. We conclude that patients with severe valproic acid intoxication may benefit from secondary detoxication. In addition to generally known symptoms valproic acid intoxication may also be associated with cardiac arrhythmias.
authors.affiliation: Department of Pediatrics/Pediatric Intensive Care, University Hospital of the Saarland, Homburg/Saar, Germany. sascha.meyer@uniklinik-saarland.de
authors.forename: S
authors.initials: S
authors.lastname: Meyer
authors.forename: M K
authors.initials: MK
authors.lastname: Kuhlmann
authors.forename: F T
authors.initials: FT
authors.lastname: Peters
authors.forename: H G
authors.initials: HG
authors.lastname: Limbach
authors.forename: A
authors.initials: A
authors.lastname: Lindinger
mesh_terms: D000293:Adolescent; D000641:Ammonia / Q000097:blood; D000927:Anticonvulsants / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000506:poisoning*; D001281:Atrial Fibrillation / Q000097:blood / Q000139:chemically induced* / Q000175:diagnosis / Q000628:therapy; D003128:Coma / Q000097:blood / Q000139:chemically induced / Q000628:therapy; D003422:Critical Care; D062787:Drug Overdose / Q000097:blood / Q000175:diagnosis / Q000628:therapy*; D004562:Electrocardiography; D006464:Hemoperfusion; D006801:Humans; D008297:Male; D013406:Suicide, Attempted; D014635:Valproic Acid / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000506:poisoning*
chemical_list: D000927:Anticonvulsants; D014635:Valproic Acid; D000641:Ammonia