Highest reported clearance of valproate by hemodialysis in massive overdose

Other studies have suggested that ECTR be initiated at lower levels (>700 mg/L) [6].2 Case report A 29-year-old male presented to a local emergency department after an overdose on an unknown amount of divalproex (Depakote DR®; North Chicago, Il, AbbVie Inc.). Urine gas chromatography/mass spectro...

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Bibliographic Details
Published inThe American journal of emergency medicine Vol. 39; pp. 255.e5 - 255.e6
Main Authors Sidlak, Alexander M., York, Samuel R., Janicki, Adam J., Pizon, Anthony F.
Format Journal Article
LanguageEnglish
Published United States Elsevier Inc 01.01.2021
Elsevier Limited
Subjects
Acids
Adult
Anticonvulsants - poisoning
Blood pressure
Caffeine
Coma
Creatinine
Drug overdose
Drug Overdose - therapy
Edema
Emergency medical care
Gas chromatography
Hemodialysis
Humans
Hyperammonemia
Male
Mass spectroscopy
Metabolism
Nicotine
Overdose
Potassium
Propofol
Proteins
Renal Dialysis - methods
Valproic acid
Valproic Acid - poisoning
LOS
Hemodialysis
VPA
Hyperammonemia
Valproic acid
ECTR
HD
ED
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Summary:Other studies have suggested that ECTR be initiated at lower levels (>700 mg/L) [6].2 Case report A 29-year-old male presented to a local emergency department after an overdose on an unknown amount of divalproex (Depakote DR®; North Chicago, Il, AbbVie Inc.). Urine gas chromatography/mass spectrometry (GC/MS) identified valproic acid, propofol, nicotine, caffeine, and hydroxyzine. In a case report with detailed toxicokinetic data, clearance ranged from 76 to 99 mL/min [5]. Because of variability in clearance and possible measurement error in valproic acid levels with dilution, it's possible that clearance in this case was not substantially different than the highest clearances achieved in the literature.
ISSN:0735-6757
1532-8171
DOI:10.1016/j.ajem.2020.06.073