High-Flux Hemodialysis and Levocarnitine in the Treatment of Severe Valproic Acid Intoxication

V Temel,Müge Arikan,G Temel

doi:10.1155/2013/526469

Abstract

Valproic acid (VPA) intoxication incidence is increasing, because of the use of VPA in psychiatric disorders. The most common finding of VPA intoxication is central nervous system depression which leads to coma and respiratory depression. Pancreatitis, hyperammonemia, metabolic, and bone marrow failure (thrombocytopenia and leukopenia) have also been described. Treatment is mainly supportive. We present the case of an 18-year-old female patient, who made an attempt to autolysis with VPA. Our patient's VPA plasma level was very high (924 μg/mL), confirming that it was a severe intoxication. Our treatment including levocarnitine (50 mg/kg per day for 3 days), and high-flux hemodialysis was performed for four hours. The patient's hemodynamic status and mental function improved in conjunction with the acute reduction in VPA concentrations. Her subsequent hospital course was complicated by transient thrombocytopenia and levocarnitine induced hypophosphatemia. By day 6, the patient's laboratory values had completely normalized, and she was transferred to an inpatient psychiatric facility for continuing therapy.

Highlights

Valproic acid (VPA) is increasingly used in the treatment of epilepsy and prescribed for bipolar affective disorders, schizoaffective disorders, schizophrenia, and migraine prophylaxis [1].Valproic acid intoxication with suicide attempt is a relatively common clinical problem that can result in coma, respiratory depression, pancytopenia, hemodynamic instability, and death [2].The treatment of VPA toxicity is mainly supportive
Various extracorporeal techniques for managing VPA toxicity have been described, but none has prevailed as standard therapy [4]
We present a patient in which high-flux hemodialysis and levocarnitine were administered for severe VPA intoxication

Summary

Case Report

High-Flux Hemodialysis and Levocarnitine in the Treatment of Severe Valproic Acid Intoxication. Valproic acid (VPA) intoxication incidence is increasing, because of the use of VPA in psychiatric disorders. Our patient’s VPA plasma level was very high (924 μg/mL), confirming that it was a severe intoxication. Our treatment including levocarnitine (50 mg/kg per day for 3 days), and high-flux hemodialysis was performed for four hours. The patient’s hemodynamic status and mental function improved in conjunction with the acute reduction in VPA concentrations. Her subsequent hospital course was complicated by transient thrombocytopenia and levocarnitine induced hypophosphatemia. By day 6, the patient’s laboratory values had completely normalized, and she was transferred to an inpatient psychiatric facility for continuing therapy

Introduction

Arterial blood gasesses pH

Discussion