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} }
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…
37 Citations
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References
SHOWING 1-10 OF 50 REFERENCES
[Hemoperfusion in the treatment of acute valproic acid intoxication].
- Medicine, PsychologyNefrologia : publicacion oficial de la Sociedad Espanola Nefrologia
- 2007
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
- MedicineActa paediatrica
- 2001
A case of VPA intoxication that was successfully treated with a combination of MDAC, forced diuresis and continuous arteriovenous haemo 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
- Medicine, BiologyJournal of toxicology. Clinical toxicology
- 2004
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
- Medicine, BiologyPediatric Nephrology
- 2002
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
- Medicine, BiologySeminars in dialysis
- 2005
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.
- MedicineThe American journal of emergency medicine
- 2008
Severe valproic acid intoxication: case study on the unbound fraction and the applicability of extracorporeal elimination
- MedicineEuropean journal of emergency medicine : official journal of the European Society for Emergency Medicine
- 2009
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
- MedicineJournal of toxicology. Clinical toxicology
- 2002
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.
- Medicine, BiologyVeterinary and human toxicology
- 1996
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.
- Medicine, BiologyTherapeutic drug monitoring
- 1999
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.