Extracorporeal elimination in acute valproic acid poisoning

@article{Thanacoody2009ExtracorporealEI,
  title={Extracorporeal elimination in acute valproic acid poisoning},
  author={Ruben H K Thanacoody},
  journal={Clinical Toxicology},
  year={2009},
  volume={47},
  pages={609 - 616}
}
  • R. Thanacoody
  • Published 1 August 2009
  • Medicine, Biology
  • Clinical Toxicology
Introduction. Valproic acid (VPA) is an antiepileptic drug that is now used for a variety of neurological and psychiatric indications. Clinical manifestations of severe VPA poisoning include central nervous system depression, hypotension, electrolyte and acid–base disturbances, and hyperammonemia. Although extracorporeal methods have been used to enhance VPA elimination, the indications for and effectiveness of these methods have not been fully characterized. Methods. A systematic literature… 
Severe valproate induced hyperammonemic encephalopathy successfully managed with peritoneal dialysis
  • Amandeep Kumar, A. Suri, B. Sharma
  • Medicine, Psychology
    Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine
  • 2014
TLDR
It is reported that a case of VIH and life-threatening VHE in a postoperative neurosurgical patient that was managed successfully with peritoneal dialysis is reported.
FAVOURABLE RESULTS FOR L-CARNITINE USE IN VALPROIC ACID ACUTE POISONING
TLDR
The use of Lcarnitine accelerates the elimination of VPA and facilitates the decrease in ammonia plasma levels, which results in significant reductions in ammonemia and plasma VPA levels.
Favorable results after conservative management of 316 valproate intoxicated patients
  • S. Shadnia, H. Amiri, N. Zamani
  • Medicine
    Journal of research in medical sciences : the official journal of Isfahan University of Medical Sciences
  • 2015
TLDR
According to this study, older age, ingestion of higher amounts of VPA and lower PCO2, HCO3, base excess, and CPK levels prone the patients to more severe toxicities in univariate analysis, but the main poor prognostic factor is coma on presentation in multivariate analysis.
L-carnitine vs extracorporeal elimination for acute valproic acid intoxication: a systematic review
TLDR
Based on the available evidence, it is reasonable to consider L-carnitine for patients with acute valproic acid overdose and in case of severe poisoning, extracorporeal therapy would also be considered in the early phase of treatment.
Extracorporeal Treatments for Poisoning : Overview and Limitations
TLDR
Intermittent hemodialysis (IHD) is the most commonly used extracorporeal modality in acute kidney injury (AKI), end-stage renal disease (ESRD), and poisoning and is increasingly available even in developing countries and is familiar to healthcare personnel who attend to patients with either AKI or ESRD.
L-Arginine in the treatment of valproate overdose – five clinical cases
TLDR
The results suggest that l-arginine may be beneficial in selected cases of valproate overdose complicated by hyperammonemia, and could extend conventional treatment options for valproic acid overdose.
Extracorporeal treatment for valproic acid poisoning: Systematic review and recommendations from the EXTRIP workgroup
TLDR
The workgroup concluded that VPA is moderately dialyzable in the setting of overdose and made the following recommendations: ECTR is recommended in severe VPA poisoning, and intermittent hemoperfusion or continuous renal replacement therapy (2D) is an acceptable alternative.
L-carnitine does not improve valproic acid poisoning management: a cohort study with toxicokinetics and concentration/effect relationships
TLDR
A single-center cohort study including all VPA-poisoned patients admitted to the intensive care unit found no significant contribution of L-carnitine to enhancing VPA elimination, accelerating blood lactate level normalization and/or preventing organ dysfunction.
Drug-induced hyperlactatemia
TLDR
Hyperlactatemia is a relatively rare but life-threatening toxicity of various medication classes and some toxicities are subject to specific antidotal treatment.
...
1
2
3
4
...

References

SHOWING 1-10 OF 50 REFERENCES
[Hemoperfusion in the treatment of acute valproic acid intoxication].
Valproic acid is increasingly used in the treatment of epilepsy, and also prescribed for bipolar affective disorders, schizoaffective disorders, schizophrenia and migraine prophylaxis. Valproic acid
Effectiveness of haemofiltration in valproic acid intoxication
TLDR
A case of VPA intoxication that was successfully treated with a combination of MDAC, forced diuresis and continuous arteriovenous haemoŽ ltration (CAVH) and the boy’s neurological condition and liver function had returned to normal values.
Successful Use of Hemodialysis in Acute Valproic Acid Intoxication
TLDR
A 41-year-old, 70-kg, white man was admitted to the emergency department of the authors' hospital after selfreported ingestion of about 50,000 mg valproic acid as extended-release 500 mg tablets and was discharged 48h after admission.
Extracorporeal removal of toxic valproic acid levels in children
TLDR
Both conventional hemodialysis and high-flux hemodiafiltration are effective treatment modalities that should be offered to all pediatric patients with valproic acid ingestion and neurological compromise.
Extracorporeal Management of Valproic Acid Toxicity: A Case Report and Review of the Literature
TLDR
A patient with VPA toxicity who was successfully treated with “in‐series” hemodialysis and hemoperfusion followed by continuous venovenous hemodiafiltration is presented and the literature on the management of VPAoxicity using extracorporeal therapies is reviewed.
A case of hemoperfusion and L-carnitine management in valproic acid overdose.
Severe valproic acid intoxication: case study on the unbound fraction and the applicability of extracorporeal elimination
TLDR
The clinical significance of applying continuous veno-venous haemofiltration in VPA intoxication because of protein-binding saturation is illustrated, and when extracorporeal elimination should be considered is suggested.
Valproic Acid Toxicity: Overview and Management
TLDR
The pharmacology and toxicology of valproic acid toxicity is reviewed and the use of controversial adjunctive therapies, including extracorporeal drug elimination and l-carnitine supplementation, will be discussed.
Hemodialysis and hemoperfusion for treatment of valproic acid and gabapentin poisoning.
TLDR
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.
Valproic acid toxicokinetics: serial hemodialysis and hemoperfusion.
TLDR
In this specific case of a severe valproic acid intoxication, saturated protein binding resulted in an increased fraction of unbound valprooic acid, which made hemodialysis an effective treatment, while hemoperfusion was relatively less effective because of saturation of the column.
...
1
2
3
4
5
...