title: Life-threatening sodium valproate overdose: a comparison of two approaches to treatment.
abstract: OBJECTIVE
  To describe two identical cases of severe sodium valproate overdose treated with two different approaches.
  
  
  METHODS
  Case report and review of the literature.
  
  
  METHODS
  Two cases of identical life-threatening valproate (VPA) overdose with high VPA blood levels, markedly elevated ammonia levels and coma.
  
  
  METHODS
  One patient was treated with supportive therapy alone until the development of cerebral edema and seizures; the other was treated with immediate extended hemodialysis followed by high-volume hemodiafiltration.
  
  
  RESULTS
  The first patient remained critically ill with elevated VPA and ammonia levels until the development of seizures and life-threatening cerebral edema. After the delayed application of hemofiltration, the patient slowly recovered to be discharged from intensive care on day 11. In contrast, the second patient's VPA and ammonia levels rapidly declined with hemodialysis and hemodiafiltration with rapid clinical improvement and intensive care discharge on day 3.
  
  
  CONCLUSIONS
  In severe VPA overdose, early intervention with blood purification of suitable intensity was associated with a rapid reduction in VPA and ammonia levels and clinical improvement. This improvement was not seen with supportive therapy alone.
authors.affiliation: Department of Intensive Care, Austin Hospital, Melbourne, Australia.
authors.forename: Elisa
authors.initials: E
authors.lastname: Licari
authors.forename: Paolo
authors.initials: P
authors.lastname: Calzavacca
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Warrillow
authors.forename: Rinaldo
authors.initials: R
authors.lastname: Bellomo
mesh_terms: D000328:Adult; D018692:Antimanic Agents / Q000008:administration & dosage* / Q000506:poisoning*; D062787:Drug Overdose; D004638:Emergency Treatment / Q000379:methods*; D005260:Female; D006801:Humans; D011041:Poisoning / Q000628:therapy; D014635:Valproic Acid / Q000008:administration & dosage* / Q000506:poisoning*
chemical_list: D018692:Antimanic Agents; D014635:Valproic Acid